Fampridine and walking

Rabadi MH, Kreymborg K, Vincent AS. Sustained-Release Fampridine (4-Aminopyridine) in Multiple Sclerosis: Efficacy and Impact on Motor Function. Drugs R D. 2013 Jul. [Epub ahead of print]

OBJECTIVE: The aim of this study was to determine the efficacy of sustained-release fampridine (4-aminopyridine) in veterans with multiple sclerosis (MS) with limited ambulatory ability, and its impact on motor function in an outpatient setting.
PARTICIPANTS:  Veterans; 20 MS patients were prescribed dalfampridine (10 mg twice daily) due to their difficulty with walking based on patient and caregiver report and clinician impression of change in the ability to ambulate based on prior 10-meter (10M) and 2-minute walk tests (2MWTs).
MAIN OUTCOME MEASURES:  The primary outcome measures were mean changes in walking speed (10M walk test), walking distance (2MWT), and Total Functional Independence Measure (TFIM). Improvement of >20 % in walking speed was indicated as a clinically meaningful change.
RESULTS: Treatment with dalfampridine resulted in significant improvement in walking speed and endurance (p < 0.05). Walking speed increased by 33 % and walking endurance by 31 %, representing clinically meaningful improvement. This change was not influenced by change in muscle tone. This improvement in mobility was associated with a clinically significant change in motor function. Adverse effects, including insomnia, dizziness, and headache, were experienced by five patients who discontinued the medication after a minimum of 4 weeks.
CONCLUSION: Treatment with dalfampridine resulted in clinically relevant improvements in walking speed and endurance in MS patients with limited ambulation and helped improve their motor function

Well you can all read and as we know already dalfampridine can be beneficial in walking speeds in some MSers,others do not benefit.
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  • In the states 4-AP is offered to MS patients who have difficulty walking even with high EDSS. Curious on its prevalence in UK. Are patients offered this treatment (i.e. is it covered by NHS)?

    • The NHS will not fund fampridine on the basis of cost and lack of tangible efficacious evidence. The NHS refuses to take progressive MS seriously because RRMS is easier and cheaper to fund.

  • Free to trial for the first month in Australia, which is good news as Biogen indicates it will only work in about 35% of cases. They suggest that walking speed improvement should become apparent by two weeks. Others are finding relief from MS fatigue. Because the drug is not funded on our subsidised pharmaceutical benefit scheme at the moment, many people are getting compounded slow release versions made up. So if you can get hold of a script for 4 -aminopyridine and you have relatives in Australia, or want to approach pharmacies directly that dispense by post – ask if they will send overseas – however if your country does not have regulatory approval for the drug efforts may be in vane.

    And yes the Ashes have returned to their rightful home!

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