Contributions
Abstract: EP1361
Type: ePoster
Abstract Category: Clinical aspects of MS - 7 MS symptoms
Background: The Spanish Neurological Society (SEN) 2013 consensus guidelines on the treatment of generalized multiple sclerosis (MS) spasticity recommend early control of spasticity triggers and other external factors and initiation of physiotherapy. At the stage where spasticity becomes troublesome and pharmacological treatment is required, the guidance reflects that the type of spasticity (generalized or focal/regional) determines two separate treatment pathways: while botulinum toxin is the option for focalized cases, baclofen or tizanidine are first-line treatments of choice for generalized spasticity. Diazepam is acknowledged also as an effective treatment for generalized spasticity but associated sedation advices to limit its use. In patients who respond inadequately to baclofen or tizanidine as monotherapy, second-line options are the use of THC+CBD oromucosal spray (Sativex) as add-on therapy or to use baclofen + tizanidine in combination; non-responders to each option can be switched over to the alternate option.
Aim: Dimension the adherence in Spanish multiple sclerosis units to the SEN 2013 consensus guidelines on the treatment of MS spasticity.
Methods: Retrospective, multicenter data collection of MS moderate to severe spasticity patients' features and treatments. Patients should have reached at least a second drug treatment at recruitment moment, and the data collected on MS and MS spasticity will go back in time as much as possible.
Results: 36 MS units were involved, data from 215 patients analyzed. Baseline data: mean age 52y, 62% women, mean 15y since MS diagnosis, mean EDSS score of 5.6, mean spasticity Ashworth scale score of 7.7(n=76), mean spasticity 0-10 NRS score of 2.7(n=52). Regarding their MS spasticity management, 48% had resourced to rehabilitation/physiotherapy and 2% to botulinum toxin. The first line generalized spasticity drug treatments reported were: 81% baclofen, 23% tizanidine,, 16% benzodiacepines, 24% others. Second line treatments were: 7% baclofen + tizanidine, 94%, baclofen or tizanidine + THC:CBD spray.
Conclusions: The 2013 SEN MS spasticity management guidelines are heterogeneously followed across cases and centers. Reported use of rehabilitation/physiotherapy seems low, botulinum toxin use reflects a limited identification of partial spasticity, baclofen is widely used as first line therapy, while use of THC:CBD as add-on is common in second line. Further educational activities on these guidelines seem required.
Disclosure: Study sponsored by Almirall S.A.. No other conflicts of interest apply.
Abstract: EP1361
Type: ePoster
Abstract Category: Clinical aspects of MS - 7 MS symptoms
Background: The Spanish Neurological Society (SEN) 2013 consensus guidelines on the treatment of generalized multiple sclerosis (MS) spasticity recommend early control of spasticity triggers and other external factors and initiation of physiotherapy. At the stage where spasticity becomes troublesome and pharmacological treatment is required, the guidance reflects that the type of spasticity (generalized or focal/regional) determines two separate treatment pathways: while botulinum toxin is the option for focalized cases, baclofen or tizanidine are first-line treatments of choice for generalized spasticity. Diazepam is acknowledged also as an effective treatment for generalized spasticity but associated sedation advices to limit its use. In patients who respond inadequately to baclofen or tizanidine as monotherapy, second-line options are the use of THC+CBD oromucosal spray (Sativex) as add-on therapy or to use baclofen + tizanidine in combination; non-responders to each option can be switched over to the alternate option.
Aim: Dimension the adherence in Spanish multiple sclerosis units to the SEN 2013 consensus guidelines on the treatment of MS spasticity.
Methods: Retrospective, multicenter data collection of MS moderate to severe spasticity patients' features and treatments. Patients should have reached at least a second drug treatment at recruitment moment, and the data collected on MS and MS spasticity will go back in time as much as possible.
Results: 36 MS units were involved, data from 215 patients analyzed. Baseline data: mean age 52y, 62% women, mean 15y since MS diagnosis, mean EDSS score of 5.6, mean spasticity Ashworth scale score of 7.7(n=76), mean spasticity 0-10 NRS score of 2.7(n=52). Regarding their MS spasticity management, 48% had resourced to rehabilitation/physiotherapy and 2% to botulinum toxin. The first line generalized spasticity drug treatments reported were: 81% baclofen, 23% tizanidine,, 16% benzodiacepines, 24% others. Second line treatments were: 7% baclofen + tizanidine, 94%, baclofen or tizanidine + THC:CBD spray.
Conclusions: The 2013 SEN MS spasticity management guidelines are heterogeneously followed across cases and centers. Reported use of rehabilitation/physiotherapy seems low, botulinum toxin use reflects a limited identification of partial spasticity, baclofen is widely used as first line therapy, while use of THC:CBD as add-on is common in second line. Further educational activities on these guidelines seem required.
Disclosure: Study sponsored by Almirall S.A.. No other conflicts of interest apply.