Upper motor neuron evaluation in multiple sclerosis patients treated with Sativex®

A. Carotenuto, R. Iodice, M. Petracca, M. Inglese, I. Cerillo, S. Cocozza, C. Saiote, A. Brunetti, E. Tedeschi, F. Manganelli, G. Orefice

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15 Scopus citations


Background: Spasticity in multiple sclerosis (MS) results from an imbalance of inputs from descending pathways to the spinal motor circuits, as well as from a damage of the corticospinal tract (CST). Objectives: To assess CST impairment in MS patients with and without spasticity and to evaluate its evolution under Sativex® treatment. Methods: Ten MS patients with spasticity (“cases”) underwent clinical (EDSS, 9-hole Peg, Ashworth scale, Timed 25-Foot Walk, and NRS for spasticity), MRI (CST fractional anisotropy [FA]), and electrophysiological (central motor conduction time [CMCT] and H/M ratio) evaluations at baseline and after 12 months. We selected 20 MS patients without spasticity as control group at baseline. Results: At baseline, cases showed a lower CST FA (0.492±0.045 vs 0.543±0.047; P=.01) and a higher CMCT (P=.001) compared to the control group. No correlations were found between clinical, electrophysiological, and MRI features. After 12 months, cases showed a decrease in non-prevalent degree of impairment (PDI) side FA (0.502±0.023 vs 0.516±0.033; P=.01) without differences for electrophysiological features compared to baseline. Treatment with Sativex® resulted in a reduction of NRS for spasticity (P=.01). Conclusions: We confirm the presence of CST impairment in MS patients with spasticity. We did not identify structural/electrophysiological correlates that could explain Sativex® clinical effect.

Original languageEnglish (US)
Pages (from-to)442-448
Number of pages7
JournalActa Neurologica Scandinavica
Issue number4
StatePublished - Apr 1 2017

Bibliographical note

Publisher Copyright:
© 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd


  • Sativex
  • corticospinal tract
  • electrophysiological assessment
  • multiple sclerosis
  • spasticity


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