Abstract
In patients with multiple sclerosis (MS), a typical pattern of muscle tone alteration, known as spasticity, is frequently observed in combination with other signs or symptoms such as spasms, cramps, pain, bladder dysfunction, sleep disturbances, fatigue, and tremor. Recently, the concept of spasticity-plus syndrome (SPS) has been proposed to take into account the frequent coexistence of all these complaints in patients with MS and a common pathophysiological basis for this putative new clinical entity has been proposed. Muscle tone, sleep, bladder function, and the pain pathway are controlled by cannabinoid CB1 (CB1R) and CB2 receptors (CB2R) that are particularly enriched in the brainstem. Axons with smaller diameters are particularly susceptible to conduction block and the irritative, ephaptic, consequences of demyelination and their involvement in the demyelination process caused by MS in the brainstem might underlie the various clinical manifestations of SPS. The adoption of SPS in clinical practice could be useful to improve symptomatic treatments in a significant proportion of patients with MS, possibly limiting the adverse events produced by polypharmacotherapy.
Highlights
NARROW CONCEPT OF SPASTICITYClinical neurology generally refers to spasticity as a well-defined clinical sign characterized by a velocity-dependent increase of muscle tone (hypertonus) that can be objectivated during the neurological examination (1, 2)
Specialty section: This article was submitted to Multiple Sclerosis and Neuroimmunology, a section of the journal Frontiers in Neurology
Sleep, bladder function, and the pain pathway are controlled by cannabinoid CB1 (CB1R) and CB2 receptors (CB2R) that are enriched in the brainstem
Summary
Clinical neurology generally refers to spasticity as a well-defined clinical sign characterized by a velocity-dependent increase of muscle tone (hypertonus) that can be objectivated during the neurological examination (1, 2). The clinical practice of multiple sclerosis (MS) teaches us that spasticity is a sign to be objectified, but it can be better captured taking into account the subjective complaints or sensations of altered muscle tone and pain occurring during daily activities. It is usually reported by patients and its severity can be described by subjective and objective items reported, respectively, in the Numeric Rating Scale (NRS, variable on a scale of 0–10, where 0 is no spasticity and 10 is the worst possible spasticity), and in the Ashworth Scale (AS, variable from 0—no spasticity to 4—affected parts rigid in flexion or extension) (2), among other scales. This model is not able to cover all the possible eventualities that recur in clinical practice
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