Effects of dalfampridine on multi-dimensional aspects of gait and dexterity in multiple sclerosis among timed walk responders and non-responders

Lo, Albert; Ruiz, Jennifer A.; Koenig, Claire M.; Anderson, Boyd; Olson, Kayla M.; Triche, Elizabeth W.

doi:10.1016/j.jns.2015.06.008

Cited by 20 publications

(19 citation statements)

References 32 publications

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“…(2014) did not improve in their performance in the 9‐HPT following dalfampridine treatment. Other studies, though, have reported improvements in the 9‐HPT in dalfampridine‐treated patients (Allart et al., 2015; Jensen et al., 2014; Lo et al., 2015; Pavsic et al., 2015) while Savin et al. (2016) detected positive effects of dalfampridine treatment only on the dominant hand.…”

Section: Discussionmentioning

confidence: 99%

Dalfampridine effects on cognition, fatigue, and dexterity

et al. 2016

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ObjectivesDalfampridine exerts beneficial effects on walking ability in a subgroup of patients with multiple sclerosis (MS). These patients are termed “responders”. Here, we investigated whether the responder status with respect to mobility measures would determine whether dalfampridine treatment exerts a beneficial effect on other MS symptoms. We therefore assessed walking ability, upper limb function, cognition, fatigue, visual evoked potentials (VEPs), depression, and quality of life in patients before and after dalfampridine treatment.MethodsPatients with MS and impaired mobility were recruited. Maximal walking distance, timed 25 Foot Walk, nine hole peg test, paced auditory serial addition test (PASAT), fatigue severity scale (FSS), VEPs, Beck Depression Inventory (BDI), EuroQol five dimensional questionnaire, and quality of life visual analogue scale were determined before and after 12–14 days of dalfampridine treatment. Repeated measures analysis of variance was applied to determine the effect of dalfampridine treatment.ResultsOf the 34 patients who completed the study, 22 patients were responders and 12 patients nonresponders, according to their performance in mobility measures. Treatment effects for the entire patient cohort were observed for PASAT (p = .029) and BDI (p = .032). Belonging to the responder cohort did not predict the response to treatment in these tests. For the FSS, response to dalfampridine treatment was dependent on the responder status (p = .001) while no effects in the total patient cohort were observed (p = .680). Other neurological functions remained unaltered. For VEP latencies, no significant improvements were detected.ConclusionIn this study, we observed beneficial effects of dalfampridine on cognition, depression, and fatigue. These effects were not limited to patients who responded to dalfampridine with improved mobility measures. These findings underscore the need to assess the beneficial effects of dalfampridine on neurological deficits in MS patients in additional randomized clinical trials.

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Section: Discussionmentioning

confidence: 99%

Dalfampridine effects on cognition, fatigue, and dexterity

et al. 2016

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“…6,7 Prolonged-release (PR) fampridine blocks voltage-gated potassium channels, thereby improving signal conduction in demyelinated nerve fibers. 8,9 Whereas beneficial effects of short-term treatment with PR fampridine on maximal walking speed [10][11][12][13][14] and additional functional outcomes 7,[13][14][15] (e.g., walking endurance) are wellcharacterized in PwMS, little information exists regarding the long-term safety and efficacy of therapy with PR fampridine. Open-label treatment over periods of 1 and 3 years demonstrated good tolerability and persisting improvement in ambulatory function 16 and fatigue.…”

Section: Classification Of Evidencementioning

confidence: 99%

Monitoring long-term efficacy of fampridine in gait-impaired patients with multiple sclerosis

et al. 2017

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Objective: To expand upon the limited knowledge of the long-term effects of prolonged-release (PR) fampridine in patients with multiple sclerosis (PwMS) regarding safety, walking improvements, and changes in drug responsiveness. Methods: Fifty-three PwMS who completed the FAMPKIN core study were included in this extension trial. Drug efficacy was assessed in an open-label and randomized doubleblind, placebo-controlled study design with regular baseline assessments over a period of 2 years using the Timed 25-Foot Walk (T25FW), 6-Minute Walk Test (6MWT), and 12-item MS Walking Scale (MSWS-12) as outcome measures. Results: The data showed good tolerability and persisting efficacy of PR fampridine during long-term treatment in PwMS. Significant improvements in walking speed, endurance, and self-perceived ambulatory function were observed during open-label (T25FW: +11.5%; 6MWT: 10.7%; MSWS-12: 6.1 points) and double-blind controlled treatment with PR fampridine (T25FW: +13.1%; 6MWT: 11.9%; MSWS-12: 7.4 points). Several patients showed changes in drug responsiveness over time, resulting in an increased proportion of patients exceeding 10% or 20% improvements in walking measures after long-term treatment. Conclusions: Efficacy and tolerability data confirmed PR fampridine as a valuable long-term treatment for improving ambulatory function in gait-impaired PwMS. Similar results in open-label and double-blind phases reveal that the walking tests used are objective and reliable. The considerable proportion of patients in whom responsiveness to PR fampridine changed over time emphasizes the importance of regular reassessment of drug efficacy in clinical practice to optimize treatment. Such reassessments seem to be particularly important in patients with poor initial drug responses, as this group demonstrated enhanced responsiveness after long-term treatment. Monitoring long-term efficacy of fampridine in gait-impaired patients with multiple sclerosis ABSTRACT Objective: To expand upon the limited knowledge of the long-term effects of prolonged-release

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“…Secondary Criteria Other walking tests, such as the 2-Minute Walk Test (2MWT) [19,23,25,27] or the 6-Minute Walk Test (6MWT), were sometimes used in association with the T25FW to evaluate endurance [16,20,28,29]. The most recent studies [17,18,28] also used the 6-Spot Step Test to evaluate coordination and balance while walking. Of these, 2 studies conducted an analysis of spatiotemporal gait parameters [19,20].…”

Section: Principal Criterionmentioning

confidence: 99%

“…A total of 9 studies completed objective analysis of gait subjectively by taking into account walking conditions in everyday life using the 12-item Multiple Sclerosis Walking Scale (MSWS-12) [8,9,14,16,19,21,24,27,28,30]. This subjective evaluation of walking is specific to MS and includes 12 items scored on a 5-level Likert scale.…”

Section: Principal Criterionmentioning

confidence: 99%

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Multiple Sclerosis and Clinical Gait Analysis before and after Fampridine: A Systematic Review

Lecat¹,

Decavel²,

Magnin³

et al. 2017

Eur Neurol

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Background: Gait impairment is one of the most disabling symptoms in people with multiple sclerosis (PwMS). Fampridine, has demonstrated a positive effect on gait speed in PwMS after 14 days of treatment but the long-term effects have not yet been demonstrated. This study reviews the long-term effects of fampridine on gait in PwMS. Summary: This systematic review was conducted according to the PRIS-MA statement. Studies were considered long term if treatment exceeded 28 days. From the 498 studies identified, 18 (2,200 patients) fulfilled all eligibility criteria. Only 3 studies followed-up patients for >1 year and one of these showed a non-significant improvement in the gait speed. Key Messages: Fampridine seems to be beneficial at improving gait speed in PwMS in the long term. Further long-term studies are needed on related gait and functional parameters.

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Effects of dalfampridine on multi-dimensional aspects of gait and dexterity in multiple sclerosis among timed walk responders and non-responders

Cited by 20 publications

References 32 publications

Dalfampridine effects on cognition, fatigue, and dexterity

Dalfampridine effects on cognition, fatigue, and dexterity

Monitoring long-term efficacy of fampridine in gait-impaired patients with multiple sclerosis

Multiple Sclerosis and Clinical Gait Analysis before and after Fampridine: A Systematic Review

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