Skip to main content

Advertisement

SpringerLink
Log in

Walking improvements with nabiximols in patients with multiple sclerosis

  • Original Communication
  • Published:
Journal of Neurology Aims and scope Submit manuscript

Abstract

Recently, nabiximols was approved as a treatment in MS spasticity. Data leading to approval and clinical use of nabiximols, although widely recognised, are based on subjective scales. Movement analysis procedures would obtain more detailed data about the impact on mobility. The aim of the study was to quantitatively assess the functional modification of gait patterns induced by nabiximols in MS. We evaluated three-dimensional gait analysis (spatial–temporal and kinematic) variation by means of one-way ANOVA. Twenty patients were enrolled—9 male and 11 female—with mean EDSS of 5.3 (SD ± 0.81) and mean reduction of numerical rating scale during nabiximols treatment of 1.88. The spatial–temporal parameters of gait revealed an increased speed (+15 %, p < 0.001), cadence (+6 %, p < 0.001) and stride length (+10 %, p < 0.001) after treatment. Regarding the kinematics data, the Gait Profile Score after treatment was reduced by 10 % (p < 0.001): Significant changes involved the pelvic area, hip rotation and knee flexion–extension. We found that nabiximols is able to improve the speed, cadence and stride length. Furthermore, the dynamics of the proximal segment of the legs and the knee movement results after treatment are closer to the physiologic values.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Shakespeare DT, Boggild M, Young C (2003) Anti-spasticity agents for multiple sclerosis. The Cochrane Library (4). Wiley, Chichester

  2. Lance JW (1980) Symposium synopsis. In: Feldman RG, Young RR, Koella WP (eds) Spasticity: disordered control. Yearbook Medical, Chicago, pp 485–494

    Google Scholar 

  3. Notcutt W, Langford R, Davies P et al (2012) A placebo-controlled, parallel-group, randomized withdrawal study of subjects with symptoms of spasticity due to multiple sclerosis who are receiving long-term Sativex® (nabiximols). Mult Scler 18:219–228

    Article  CAS  PubMed  Google Scholar 

  4. Rizzo MA, Hadjimichael OC, Preiningerova J et al (2004) Prevalence and treatment of spasticity reported by multiple sclerosis patients. Mult Scler 10(5):589–595

    Article  CAS  PubMed  Google Scholar 

  5. Oreja-Guevara C, González-Segura D, Vila C (2013) Spasticity in multiple sclerosis: results of a patient survey. Int J Neurosci 123(6):400–408. doi:10.3109/00207454.2012.762364

    Article  CAS  PubMed  Google Scholar 

  6. Gunn H, Creanor S, Haas B et al (2013) Risk factors for falls in multiple sclerosis: an observational study. Mult Scler 19(14):1913–1922. doi:10.1177/1352458513488233

    Article  PubMed  Google Scholar 

  7. Flachenecker P (2013) A new MS spasticity treatment option effect in everyday clinical practice. Expert Rev Neurother 13(3 Suppl 1):15–19. doi:10.1586/ern.13.1

    Article  CAS  PubMed  Google Scholar 

  8. Serpell MG, Notcutt W, Collin C (2013) Sativex long-term use: an open-label trial in patients with spasticity due to multiple sclerosis. J Neurol 260(1):285–295. doi:10.1007/s00415-012-6634-z

    Article  PubMed  Google Scholar 

  9. Rekand T (2014) THC:CBD spray and MS spasticity symptoms: data from latest studies. Eur Neurol 71(Suppl 1):4–9. doi:10.1159/000357742

    Article  CAS  PubMed  Google Scholar 

  10. Novotna A, Mares J, Ratcliff S et al (2011) A rabdomized double blind placebo-controlled parallel group, enriched-design study of nabiximol, as add-on therapy, in subject with refractory spasticity caused by multiple sclerosis. Eur J Neurol 18:1112–1131

    Google Scholar 

  11. Anwar K, Barnes MP (2009) A pilot study of a comparison between a patient scored numeric rating scale and clinician scored measures of spasticity in multiple sclerosis. NeuroRehabilitation 24(4):333–340. doi:10.3233/NRE-2009-0487

    PubMed  Google Scholar 

  12. Fleuren JF, Voerman GE, Erren-Wolters CV et al (2010) Stop using the Ashworth Scale for the assessment of spasticity. J Neurol Neurosurg Psychiatry 81(1):46–52. doi:10.1136/jnnp.2009.177071

    Article  CAS  PubMed  Google Scholar 

  13. Baker R, McGinley JL, Schwartz MH, Beynon S, Rozumalski A et al (2009) The gait profile score and movement analysis profile. Gait Posture 30(3):265–269. doi:10.1016/j.gaitpost.2009.05.020

    Article  PubMed  Google Scholar 

  14. Pau M, Coghe G, Atzeni C et al (2014) Novel characterization of gait impairments in people with multiple sclerosis by means of the gait profile score. J Neurol Sci 345(1–2):159–163. doi:10.1016/j.jns.2014.07.032

    Article  PubMed  Google Scholar 

  15. Polman CH, Reingold SC, Banwell B et al (2011) Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria. Ann Neurol 69(2):292–302

    Article  PubMed Central  PubMed  Google Scholar 

  16. Lechner-Scott J, Brunnschweiler H, Kappos L (1995) The Study Steering Committee. Is it possible to achieve cross-cultural European agreement in the assessment of neurological deficits? First experience in the European interferon beta-1b trial for secondary progressive MS. J Neuroimmunol 63(Suppl 1):42. doi:10.1016/0165-5728(95)98993-L

  17. Davis RB, Õunpuu S, Tyburski D et al (1991) A gait analysis data collection and reduction technique. Hum Mov Sci 10(5):575–587

    Article  Google Scholar 

  18. Flachenecker P, Henze T, Zettl UK (2014) Nabiximols (THC/CBD oromucosal spray, Sativex®) in clinical practice–results of a multicenter, non-interventional study (MOVE 2) in patients with multiple sclerosis spasticity. Eur Neurol 71(5–6):271–279. doi:10.1159/000357427

    Article  CAS  PubMed  Google Scholar 

  19. Orsnes GB, Sørensen PS, Larsen TK, Ravnborg M (2000) Effect of baclofen on gait in spastic MS patients. Acta Neurol Scand 101(4):244–248

    Article  CAS  PubMed  Google Scholar 

  20. Horn TS, Yablon SA, Stokic DS (2005) Effect of intrathecal baclofen bolus injection on temporospatial gait characteristics in patients with acquired brain injury. Arch Phys Med Rehabil 86(6):1127–1133

    Article  PubMed  Google Scholar 

  21. Molteni F, Carda S, Cazzaniga M et al (2005) Instrumental evaluation of gait modifications before and during intrathecal baclofen therapy: a 2-year follow-up case study. Am J Phys Med Rehabil 84(4):303–306

    Article  PubMed  Google Scholar 

  22. Roche N, Boudarham J, Hardy A et al (2014) Use of gait parameters to predict the effectiveness of botulinum toxin injection in the spastic Rectus Femoris muscle of stroke patients with Stiff Knee Gait. Eur J Phys Rehabil Med [Epub ahead of print]

  23. Koehler J, Feneberg W, Meier M et al (2014) Clinical experience with THC:CBD oromucosal spray in patients with multiple sclerosis-related spasticity. Int J Neurosci 124(9):652–656. doi:10.3109/00207454.2013.877460

    Article  PubMed  Google Scholar 

  24. Meldrum D, Shouldice C, Conroy R et al (2014) Test–retest reliability of three dimensional gait analysis: Including a novel approach to visualising agreement of gait cycle waveforms with Bland and Altman plots. Gait Posture 39(1):265–271

    Article  PubMed  Google Scholar 

  25. Wilken JM, Rdriguez KM, Brawner M et al (2012) Reliability and minimal detectible change values for kinematics and kinetics in healthy adults. Gait Posture 35(2):302–307

    Article  Google Scholar 

  26. Rasmussen HM, Nielsen DB, Pedersen NW et al (2015) Gait Deviation Index, Gait Profile Score and Gait Variable Score in children with spastic cerebral palsy: intra-rater reliability and agreement across two repeated sessions. Gait Posture. doi:10.1016/j.gaitpost.2015.04.019

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy

    G. Coghe, F. Corona, J. Frau, L. Lorefice, G. Fenu, M. G. Marrosu & E. Cocco

  2. Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, Cagliari, Italy

    M. Pau & F. Corona

  3. ASL 8 Cagliari, Multiple Sclerosis Centre, Cagliari, Italy

    G. Spinicci, E. Mamusa, L. Musu, S. Massole & R. Massa

Authors
  1. G. Coghe
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. Pau
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. F. Corona
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J. Frau
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. L. Lorefice
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. G. Fenu
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. G. Spinicci
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. E. Mamusa
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. L. Musu
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. S. Massole
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. R. Massa
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. M. G. Marrosu
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. E. Cocco
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to G. Coghe.

Ethics declarations

Conflicts of interest

No conflict of interest exists regarding the present paper. Dr. Coghe received speaker fee from Teva, Almirall and Novartis and research grant from Novartis. Prof. Pau received speaker fee from Serono. Dr. Corona has nothing to disclose. Dr. Frau serves on scientific advisory boards for Biogen, received honoraria for speaking from Merck Serono and Teva and received a research grant from Serono. Dr. Fenu received honoraria for consultancy from Novartis and for speaking from Merck Serono and Teva, and received a research grant from Novartis. Dr. Lorefice received speaker fee from Teva and received a research grant from Serono Dr. Spinicci received speaker fee from Biogen. Dr Mamusa received speaker fee from Biogen. Dr. Musu received honoraria for consultancy and speaker fee from Biogen. Dr Massole received speaker fee from Biogen. Dr. Massa received speaker fee from Biogen. Professor Marrosu has received honoraria for consultancy or speaking from Bayer, Biogen-Idec, Novartis, Sanofi-Genzyme, Serono, Teva and Almirall. Prof. Cocco serves on scientific advisory boards and received honoraria for speaking from Bayer, Biogen, Merck Serono, Novartis, Sanofi-Genzyme and Teva.

Ethical standard

The study has been approved by the local ethic committee and has been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Coghe, G., Pau, M., Corona, F. et al. Walking improvements with nabiximols in patients with multiple sclerosis. J Neurol 262, 2472–2477 (2015). https://doi.org/10.1007/s00415-015-7866-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00415-015-7866-5

Keywords

Search

Navigation