Spasticity reduced quality of life

Milinis K, Young CA; Trajectories of Outcome in Neurological Conditions (TONiC) study.Systematic review of the influence of spasticity on quality of life in adults with chronic neurological conditions. Disabil Rehabil. 2015:1-11. [Epub ahead of print]

To conduct a systematic review of the published evidence on the relationship between spasticity and quality of life (QOL) in chronic neurological conditions in adults.
METHODS:The databases were searched from inception to October 2014 using keywords ‘spasticity’ and ‘quality of life’ for publications in English language. Cross-sectional and longitudinal studies reporting quantitative analyses on the association between spasticity and QOL were included. Appraisal of the studies and data extraction were conducted in accordance with Strengthening the Reporting of Observational Studies in Epidemiology guidance.
RESULTS:17/652 studies (total of 27 827 patients) met inclusion criteria for review. These examined the relationship between spasticity and QOL inmultiple sclerosis (MS), spinal cord injury (SCI) and stroke. Spasticity was found to be associated with significantly lower scores on health status measures, namely SF-12, SF-36 and EQ-5D, in MS and SCI, but less so in stroke. Spasticity was associated with considerably lower scores on physical components of the health status questionnaires, but with only marginally lower scores on mental components. The studies that employed global QOL measures, such as the World Health Organisation Quality of Life – BREF, found no significant relationship between spasticity and QOL. Spasticity was often associated with pain, sleep problems, fatigue and urinary dysfunction.
CONCLUSIONS:Spasticity is associated with worse health status, however its relationship with overall QOL is not established. The relationship between spasticity and QOL is confounded by other impairments and requires multivariate analysis. Implications for Rehabilitation Effective management of spasticity may result in significant improvements in HRQOL. It is important to address multiple factors in the management of spasticity including pain, bladder problems, fatigue and sleep, as the interplay of these may have significant negative effects on HRQOL. Clinician-administered methods for measuring spasticity, such as the Ashworth scale, may not provide comprehensive assessment of spasticity. Incorporation of patient-reported measures for spasticity is pivotal in the assessment of therapeutic interventions.

So spasticity is a not surprising associated with poor outcomes on quality of life and therefore developing treatments to deal with this issue should be of benefit. 

However, proving things are of benefit is a problem. 

The Ashworth scale which is a physician assessed scale is rather insensitive to subtle change and many treatments have failed to affect this measure, but the FDA in the US seem to be hung up that this needs to be affected for approval. In Europe they have accepted numerical rating scales that are patient assessed so the bar has been set lower and so Europeans are more likely to get anti-spastics. As medical cannabis is an add-on to other drugs it is going to be hard to show an  effect on the Ashworth. 

However, it seems it is green lights in the US for stoner medicine and there is seems like the burden of proof goes out the window. I used to go to a meeting focused on cannabis research, but it is getting more and more frequented by stoner pot growers, who when asked where is the evidence that it is useful for this or that condition the stock answer is “I know I tried it on myself.”

Now , I have no beef with medical cannabis users but you need to keep a professional relationship, and not come out with bongs at meetings based in the Neherlands, or bring someone in Canada who has a medical use….or go off and “medicate”. It taints the science however

As spasticity has been a focus of some of our research for the past 15 years, you may have to get used to the posts on spasticity (sorry to the person who moaned about using the blog to support our research). When our work crashes and burns, which it may they the posts may stop but until that time some people can moan all they like. This study is not our work but it educates you about the condition and allows you to frame our work in a context. So you will learn why people may think that cannabis may work for spasms and spasticityand then you will learn how we can avoid the problems associated with cannabis use. This is science in action, this will change the diagram above

CoI We are developing a potential treatment for spasticty and are in phase II. Will the Ashworth Respond? I don’t know and I dont’t know why we are even bothering looking, but I have no control on this. We will have to wait and see. Maybe this year maybe next year you will know and I will shut up or it will be more of the same

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  • I asked before and I'm asking again, what do they mean "Previous history of other significant medical disorders"?

    • I did not write the protocol and I believes it means nothing specific apparently as I do remember asking but gives the treating physician some scope.

      When the protocol was written the doctors did not know how the drug worked so the side effect profile potential was not known. So in sativex studies a history of psychosis would be an exclusion criteria as cannabis triggers psychosis. For VSN16R may not matter by may trigger a discussion

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