Documento de consenso sobre la espasticidad en pacientes con esclerosis múltiple

Guevara, Celia Oreja; Gairín, Xavier Montalbán; Frutos, Clara de Andrés de; Estruch, Bonaventura Casanova; García, Delicias Muñoz; Garcı́a, Inmaculada; Fernández, Óscar

doi:10.33588/rn.5708.2013374

Cited by 6 publications

(9 citation statements)

References 112 publications

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“…In some cases, non-pharmacological interventions may be beneficial, e.g., physiotherapy for spasticity, but might have a limited time effect and the evidence supporting such approaches is not always strong (30), and pharmacological interventions are often considered necessary. As shown in Table 2, a wide variety of agents can be used (31,32). Any pharmacological intervention has a risk of side effects ( Table 3) and this risk is accentuated by drug-drug interaction possibilities.…”

Section: Management Of Spasticity Symptomsmentioning

confidence: 99%

The Broad Concept of “Spasticity-Plus Syndrome” in Multiple Sclerosis: A Possible New Concept in the Management of Multiple Sclerosis Symptoms

et al. 2020

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Multiple sclerosis (MS) pathology progressively affects multiple central nervous system (CNS) areas. Due to this fact, MS produces a wide array of symptoms. Symptomatic therapy of one MS symptom can cause or worsen other unwanted symptoms (anticholinergics used for bladder dysfunction produce impairment of cognition, many MS drugs produce erectile dysfunction, etc.). Appropriate symptomatic therapy is an unmet need. Several important functions/symptoms (muscle tone, sleep, bladder, pain) are mediated, in great part, in the brainstem. Cannabinoid receptors are distributed throughout the CNS irregularly: There is an accumulation of CB 1 and CB 2 receptors in the brainstem. Nabiximols (a combination of THC and CBD oromucosal spray) interact with both CB 1 and CB 2 receptors. In several clinical trials with Nabiximols for MS spasticity, the investigators report improvement not only in spasticity itself, but also in several functions/symptoms mentioned before (spasms, cramps, pain, gait, sleep, bladder function, fatigue, and possibly tremor). We can conceptualize and, therefore, hypothesize, through this indirect information, that it could be considered the existence of a broad "Spasticity-Plus Syndrome" that involves, a cluster of symptoms apart from spasticity itself, the rest of the mentioned functions/symptoms, probably because they are interlinked after the increase of muscle tone and mediated, at least in part, in the same or close areas of the brainstem. If this holds true, there exists the possibility to treat several spasticity-related symptoms induced by MS pathology with a single therapy, which would permit to avoid the unnecessary adverse effects produced by polytherapy. This would result in an important advance in the symptomatic management of MS.

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Section: Management Of Spasticity Symptomsmentioning

confidence: 99%

The Broad Concept of “Spasticity-Plus Syndrome” in Multiple Sclerosis: A Possible New Concept in the Management of Multiple Sclerosis Symptoms

et al. 2020

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“…Dentro de estos procedimientos, y a pesar de que el alcance global de la espasticidad no está bien determinado 17 , investigaciones recientes sugieren que la acupuntura constituye una terapia complementaria eficaz en el proceso rehabilitador post-ictus 18 , pudiendo lograr mejoras en la discapacidad que pueda desencadenarse en el paciente, siempre que sea empleada en fase aguda 19 . En este sentido, estudios como el de Lo et al 20 y Alexander et al 21 mostraron efectos beneficiosos a corto plazo sobre la reorganización de la plasticidad cerebral así como en la recuperación motora de la extremidad superior, respectivamente; no obstante, la falta de consenso sobre la existencia de diferencias con un grupo placebo 22 , la heterogeneidad en la combinación de técnicas aplicadas desde la acupuntura, masaje, ejercicio físico u homeopatía 23 , y el desconocimiento sobre los mecanismos neuronales responsables de los efectos observados justifican la necesidad de conocer desde la evidencia científica los efectos terapéuticos reportados por la acupuntura tradicional china como técnica indicada en la reducción de la espasticidad en el paciente que ha sufrido ictus.…”

Section: Introductionunclassified

Eficacia de la acupuntura en la espasticidad del paciente que ha padecido un ictus. Revisión sistemática

2016

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“…The perceived frequency of spasticity in our study (76%) indicates that it is a frequently observed symptom in MS (Kister et al, 2013), closely related to gait disorders, and one of the most limiting symptoms for ADL (Rizzo et al, 2004) and QoL (Flachenecker et al, 2014;(Oreja-Guevara, González-Segura, & Vila, 2013, Oreja-Guevara, Montalban, et al, 2013. Despite stiffness and spasms were the most common symptoms, 69% complained about 2 or more other associated symptoms.…”

Section: Discussionmentioning

confidence: 59%

“…However, spasticity tends to be under-treated (40% in our cohort) but polymedicated with other drugs (e.g. hypnotic drugs) and pwMS frequently show a low level of treatment satisfaction (Flachenecker et al, 2014;(Oreja-Guevara, González-Segura, & Vila, 2013, Oreja-Guevara, Montalban, et al, 2013. The reasons why this may happen are not well understood.…”

Section: Discussionmentioning

confidence: 77%

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The role of specialist nurses in detecting spasticity and related symptoms in multiple sclerosis

Artola

Hernando

Vidal

et al. 2022

Journal of Clinical Nursing

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Background Spasticity is a frequent symptom of multiple sclerosis (MS), which may negatively influence daily living activities (ADL). Objectives To (1) explore the feasibility to conduct a structured interview by specialist nurses about limitations in ADL; (2) determine the percentage of people with MS (PwMS) with limitations in ADL related to spasticity; (3) to assess the knowledge about spasticity and describe its clinical features. Design Observational, cross‐sectional, multicentre study in 16 MS units of Catalonia (Spain). Participants were recruited from the outpatient facility and day‐care hospital between July 2018 and June 2019 and met the following criteria: (1) age 18 or older, (2) diagnosis of MS according to McDonald criteria 2010 and (3) no clinical relapse in previous 30 days. Methods Specialist nurses conducted a structured interview divided in two parts: the assessment of (1) limitations in the ADL and (2) the presence of spasticity and associated symptoms. The usefulness of this intervention was requested. This study met the STROBE reporting guidelines checklist for observational studies. Results Three hundred sixty eight pwMS (244 women) with a mean age of 46 years and a median Expanded Disability Status Scale score of 2.5 (range, 0–8.5) were included. 262 (71%) pwMS had limitations in the ADL, and spasticity was reported as the most limiting symptom in 59 (23%). As a result of the interview, spasticity was observed in 199 (76%) participants; 47 (24%) of them were unaware that they had spasticity and 102 (51%) would not have reported it spontaneously. The level of the interview satisfaction was high (90%). Conclusions Spasticity is a complex and limiting symptom in MS. The structured interview conducted by specialist nurses is feasible and has good acceptance. Patient contribution Specialist nurses can be proactive in MS clinical assessment, which may help to detect symptoms with negative impact on quality of life.

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Documento de consenso sobre la espasticidad en pacientes con esclerosis múltiple

Cited by 6 publications

References 112 publications

The Broad Concept of “Spasticity-Plus Syndrome” in Multiple Sclerosis: A Possible New Concept in the Management of Multiple Sclerosis Symptoms

The Broad Concept of “Spasticity-Plus Syndrome” in Multiple Sclerosis: A Possible New Concept in the Management of Multiple Sclerosis Symptoms

Eficacia de la acupuntura en la espasticidad del paciente que ha padecido un ictus. Revisión sistemática

The role of specialist nurses in detecting spasticity and related symptoms in multiple sclerosis

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