Fampridine (4-aminopyridine) is a potassium channel blocking agent that restores conduction in demyelinated axons and improves neurologic function in patients with chronic spinal cord injury (SCI). Based on the pharmacokinetic profile of orally administered fampridine, multiple daily doses (4 or more) would need to be taken to sustain its therapeutic effects. Two studies were conducted to determine the pharmacokinetics and safety profile of an oral, sustained-release (SR) formulation of fampridine (fampridine-SR, 10-25 mg) administered as a single dose (n = 14) and twice daily for 1 week (n = 16) in patients with chronic, incomplete SCI. Mean plasma concentrations and area under the plasma concentration-time curve were proportional to the dose administered, whereas other pharmacokinetic parameters were independent of dose. Fampridine-SR was absorbed slowly (peak plasma concentration shortly after dosing, 2.6-3.7 hours) and eliminated (plasma half-life, 5.6-7.6 hours), and reached steady state after 4 days of twice-daily administration. Fampridine-SR was well tolerated, with only mild to moderate adverse events reported, and no serious adverse events. The extended plasma half-life of fampridine-SR allows convenient twice-daily dosing. Clinical trials designed to assess neurologic and functional improvement using fampridine-SR in patients with chronic SCI are currently underway.
The care of 169 survivors of spinal injury receiving acute treatment at the Hamilton General Hospital in Ontario, Canada, was studied. This paper compares treatment of groups of patients before and after formation of a multidisciplinary Acute Spinal Cord Injury Team. The establishment of multidisciplinary team care for acute spinal cord injury patients in our tertiary referral center correlates with clinically and statistically significant reductions in length of stay in the acute care hospital, alterations in the rate of surgical treatment for them, changes in the use of radiological resources, and reduction in the average number of days febrile. The team also brought stronger representation of allied health professionals to the hospital records of acute spinal cord injury patients. These important changes result from implementation of an effective multidisciplinary medical team without the addition of new funds, personnel, or hospital facilities and without alteration in referral patterns. Our team did not reduce mortality, duration of intensive care unit stay, or work for physicians.
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