Efficacy and safety of nabiximols cannabinoid medicine for paediatric spasticity in cerebral palsy or traumatic brain injury: A randomized controlled trial

WHOM are you going to ask about this working for stroke spasticity? There is NO STROKE LEADER IN THE WORLD willing to talk to or take questions from survivors. Stroke associations don't give a shit about survivors, they are only there as pity pots to generate donations.  

I don't care that this was a failure in this instance, there is this:

This has been out there for years;
Nabiximols is an oromucosal spray formulated in a 1:1 ratio of tetrahydrocannabinol and cannabidiol and approved in several countries for treatment-resistant spasticity in patients with MS. It also works for motor neuron disease spasticity. (How fucking incompetent is your doctor in not using it?)

Do your prefer your incompetence NOT KNOWING? OR NOT DOING? OR BOTH?

Just maybe you want to get your doctor educated by reading these posts:

• nabiximols (5 posts to April 2013)

 

 

Efficacy and safety of nabiximols cannabinoid medicine for paediatric spasticity in cerebral palsy or traumatic brain injury: A randomized controlled trial

Developmental Medicine & Child Neurology — Fairhurst C, Kumar R, Checketts D, et al. | April 30, 2020

Researchers conducted this multicentre, randomized, placebo‐controlled trial to evaluate the effectiveness, safety, and tolerability of oromucosal nabiximols cannabinoid medicine as adjunct therapy for children with spasticity due to cerebral palsy/traumatic central nervous system injury with inadequate response to existing treatment. In total, 72 individuals (mean [SD] age 12y 4mo [3y 1mo], range 8‒18y) were randomized at a ratio of 2:1 to receive nabiximols (n = 47; 29 males, 18 females) or placebo (n = 25; 15 males, 10 females) for 12 weeks (12 sprays/day max. based on clinical response/tolerability). Paediatric patients usually respond well to oromucosal nabiximols. Three cases of hallucinations, one of which involved auditory hallucinations and a suicide attempt, were however observed.  Oromucosal nabiximols compared with placebo did not minimize cerebral palsy/central nervous system injury‐related spasticity.

Read the full article on Developmental Medicine & Child Neurology

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

I would think your doctor would immediately prescribe Nabiximols for your spasticity. Since 30% of survivors that have it and there is absolutely nothing else for treating spasticity(botox does not cure spasticity).

This has been out there for years;
Nabiximols is an oromucosal spray formulated in a 1:1 ratio of tetrahydrocannabinol and cannabidiol and approved in several countries for treatment-resistant spasticity in patients with MS.(How fucking incompetent is your doctor in not using it?)

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

Óscar Fernández^1*, Lucienne Costa-Frossard², Marisa Martínez-Ginés³, Paloma Montero⁴, José Maria Prieto⁵ and Lluis Ramió⁶

• ¹Biomedical Research Institute of Malaga, University of Málaga, Málaga, Spain
• ²Department of Neurology, Ramón y Cajal University Hospital, Madrid, Spain
• ³Department of Neurology, Gregorio Marañón Hospital, Madrid, Spain
• ⁴Servicio de Neurología, Hospital Clínico San Carlos, Madrid, Spain
• ⁵Servicio de Neurologia, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
• ⁶Servicio de Neurologia, Hospital Universitari de Girona Doctor Josep Trueta, Girona, Spain

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 CB₁ and CB₂ receptors in the brainstem. Nabiximols (a combination of THC and CBD oromucosal spray) interact with both CB₁ and CB₂ 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.

In the last two decades, the availability of new disease-modifying therapies has radically changed the management of multiple sclerosis (MS) and relapsing–remitting MS in particular (1), resulting in a longer life expectancy for patients with the disease (2). Nevertheless, MS currently remains incurable and, in most patients, disability will eventually progress and they must live with the very many symptoms associated with the disease. These symptoms can have a major impact on patient's quality of life (3) and their management is considered important, although traditionally, this area has received far less attention than disease-modifying therapies (4).

A wide range of treatments are available to manage each of the MS symptoms (5–7). Given that different agents are used for different symptoms and a patient may have several symptoms present at the same time, many MS patients are multi-medicated, particularly as most patients will also be receiving disease-modifying therapies. This article will assess the current fragmented approaches to pharmacological management of spasticity muscle tone increase-related symptoms and their shortcomings. Given that the treatment of MS-associated muscle spasticity has been associated in a good number of clinical trials and also observational studies with the improvement of several other functions/symptoms present in MS (8), we will conceptualize, and subsequently hypothesize, about the clinical interest of introducing the more broad concept of “Spasticity-Plus Syndrome” to provide a unified framework for managing all these seemingly related functions/symptoms. By applying such a concept, it would be possible to simplify the management of symptoms associated with MS and reduce importantly the interactions and adverse effects associated with poly-medication.

Oromucosal Spray Improves Tough-to-Treat Spasticity in Patients With MS

I bet your doctor will never use this on your spasticity. I bet s/he never even hears about it. Time for you to educate your doctor again. $1000 an hour charge to your doctor sounds about right.It is cannabinoid based thus will never make it past our idiotic federal legislators having marijuana as a Class I drug.  Bet you have to go to Europe to try it.
http://www.docguide.com/oromucosal-spray-improves-tough-treat-spasticity-patients-ms?

: Presented at ECTRIMS

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• Multiple Sclerosis

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By Jill Stein
LONDON -- September 17, 2016 -- New data support the use of a cannabinoid-based oromucosal spray as an add-on option to treat multiple sclerosis (MS)-related resistant spasticity.
The results, which are drawn from a large sample of patients treated with the spray in everyday clinical practice in Europe, were presented here at the 32nd Congress of the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS).
Patrick Vermersch, MD, Universitaire de Lille, Lille, France, and colleagues collected data from 433 patients starting treatment with the spray at specialist centres in Italy, Norway, and Denmark.
The spray contains the active substances delta-9-tetrahydrocannabinol and cannabidiol (THC:CBD) at a ratio of 1:1.
The study aimed to augment the positive clinical findings from randomised clinical trials (RCTs) evaluating the spray.
All patients had moderate-to-severe MS spasticity and had not responded adequately to other anti-spasticity medications.
Effectiveness was measured by rates of treatment continuation and changes from baseline in scores on the spasticity numerical (0-10) rating scale (NRS) and the modified Ashworth scale (0-4).
After a 1-month trial period, patients who had achieved ≥20% improvement in their spasticity NRS score could continue.
Overall, 349 participants continued treatment with the spray beyond the first month visit, and 281 patients continued treatment beyond the third month visit.
Spasticity scores on all scales improved significantly improved in study completers at 3 months: 0-10 NRS (mean 6.9 to 5.4) and Ashworth scale (mean 2.6 to 2.3).
The usual 3-level categorical scale for the severity of spasticity (mild/moderate/severe) showed a marked reduction in severe cases from 37.2% to 12.9%.
The percentage of patients with no restrictions in their daily activities resulting from their spasticity was significantly reduced from 30.2% to 22.8%.
Roughly 20% of patients improved ≥30% on their NRS score.
Dr. Vermersch said that the results compare favourably with results from prior RCTs and observational studies.
Funding for this study was provided by Almirall S.A.
[Presentation title: Tetrahydrocannabinol + Cannabidiol Oromucosal Spray for Multiple Sclerosis-Resistant Spasticity on Daily Practice, New Data. Abstract P757]