Friday, 13 March 2015

Sativex inhibits spasticity

Russo M, CalabrĂ² RS, Naro A, Sessa E, Rifici C, D'Aleo G, Leo A, De Luca R, Quartarone A, Bramanti P. Sativex in the management of multiple sclerosis-related spasticity: role of the corticospinal modulation. Neural Plast. 2015;2015:656582.

Sativex is an emergent treatment option for spasticity in patients affected by multiple sclerosis (MS). This oromucosal spray, acting as a partial agonist at cannabinoid receptors, may modulate the balance between excitatory and inhibitory neurotransmitters, leading to muscle relaxation that is in turn responsible for spasticity improvement. Nevertheless, since the clinical assessment may not be sensitive enough to detect spasticity changes, other more objective tools should be tested to better define the real drug effect. The aim of our study was to investigate the role of Sativex in improving spasticity and related symptomatology in MS patients by means of an extensive neurophysiological assessment of sensory-motor circuits. To this end, 30 MS patients underwent a complete clinical and neurophysiological examination, including the following electrophysiological parameters: motor threshold, motor evoked potentials amplitude, intracortical excitability, sensory-motor integration, and Hmax/Mmax ratio. The same assessment was applied before and after one month of continuous treatment. Our data showed an increase of intracortical inhibition, a significant reduction of spinal excitability, and an improvement in spasticity and associated symptoms. Thus, we can speculate that Sativex could be effective in reducing spasticity by means of a double effect on intracortical and spinal excitability.

So this study suggests that sativex can work in the brain and spinal cord. We also showed that sativex cold work in the peripheral nerves and can work at the junction of the muscle and nerve. 

However this suggests that you can see effects of symptom control drugs within a month of beginning treatment.

CoI. We have generated an alternative

10 comments:

  1. Sativex has not been approved in the U.S. but is approved in Canada. Some countries in the E.U. have approved Sativex while others have not. There seems to be conflicting studies regarding the efficacy of Sativex. As a patient in the U.S., there is an unmet need for effective spasticity meds now not in the next 5-10 years. Do other bloggers have any experience with Sativex in controlling spasticity? It seems like this drug is caught in an infinite loop of is it effective or not.

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    1. After the furore regarding the Welsh allowing Sativex on prescription, I read about it on an NHS website. The side effects were horrible and I think I'll stick to other drugs less likely to mess with my mind.

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    2. It is caught in a UK loop of not been considered to be cost effective and so NICE won't approve it....as it is considered to be too expensive.

      Most current anti-spastics mess with your mind to some extent, it is the side effects that are the problems

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    3. The FDA want more trials and an Ashworth end point I believe.....the trials therefore may be doomed as most trials having Ashworth as an endpoint have failed. Furthermore where the Ashworth has responded it has tended to be people that are less disabled and agin I am not sure that Sativex trials have focussed on this population

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    4. Regarding sativex and other cannabinoids having cognitive side effects, is this due to a larger proportion of THC vs CBD? The medical marijuana growers have different strains of cannabis with differing ratios of cannabinoids, or so I thought.

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    5. Yes they do...it seems very high THC or phenomenally high levels of THC the CBD levels seem to be small

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  2. I'm in Canada and I use Sativex. I use it for breakthrough pain when my other meds just aren't coping at what my body throws at it. I find it better for neuropathic pain than spasticity. And I haven't tried medical marijuana, but it's certainly more convenient and socially acceptable to just squirt this in your mouth!

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    1. In Canada the intial indication approved was for neuropathic pain

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  3. Just to add onto (different) Anonymous above, does anyone have experience with Sativex in intention tremor AND spasticity?

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    1. Tremor is a harder beast to treat than spasticity based on what happens in the beasties

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