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A Protocol for the Use of Remotely-Supervised Transcranial Direct Current Stimulation tDCS in Multiple Sclerosis MS
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Positive neurologic phenomena with initiation of dalfampridine for multiple sclerosis

Greg M Thaera1, Dean M Wingerchuk1, Jonathan L Carter1

  • 1Department of Neurology, Mayo Clinic, Scottsdale, Arizona.

Multiple Sclerosis and Related Disorders
|April 17, 2015
PubMed
Abstract

Insights

Dalfampridine, used for multiple sclerosis (MS) gait issues, may trigger new or worsened positive neurologic symptoms in some patients. Discontinuation of dalfampridine did not resolve symptoms in all cases.

Area of Science:

  • Neurology
  • Pharmacology

Background:

  • Dalfampridine (4-aminopyridine) is a potassium-channel blocker used to treat gait impairment in multiple sclerosis (MS).
  • Its mechanism involves enhancing axonal conduction, which may paradoxically trigger positive neurologic phenomena.

Purpose of the Study:

  • To review cases where dalfampridine initiated or exacerbated positive neurologic phenomena in MS patients.
  • To investigate the association between dalfampridine use and the onset or recurrence of sensory or motor symptoms.

Main Methods:

  • Retrospective review of medical records.
  • Inclusion criteria: patients started on dalfampridine for activation of positive sensory or motor symptoms.

Main Results:

  • 5.3% (4 of 76) of patients developed new positive sensory symptoms within one month of starting dalfampridine.
  • One patient experienced a new-onset seizure.
  • Dalfampridine cessation was insufficient to resolve symptoms in two patients with trigeminal neuralgia.

Conclusions:

  • Initiating dalfampridine may be linked to the onset or recurrence of positive sensory symptoms in MS patients.
  • Increased axonal conduction due to potassium channel blockade might underlie this exacerbation of sensory phenomena.
Keywords:
DalfampridineMultiple sclerosisParoxysmal neurologic symptomsSeizuresSensation disordersTrigeminal neuralgia

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