Sustained-released fampridine in multiple sclerosis: effects on gait parameters, arm function, fatigue, and quality...

Sustained-release fampridine (fampridine-SR) improves gait velocity and self-perceived capacities in people with multiple sclerosis (MS). However, little is known about the treatment's effect on temporospatial gait parameters, walking endurance, general fatigue, hand function and quality of life (QoL). We therefore sought to evaluate these parameters in a real-world setting: 120 consecutive, eligible patients with MS were evaluated at baseline (D0) and after two weeks (D14) of fampridine-SR. Lastly, D14 responders were again evaluated after three months (M3). Response to treatment was defined as a 15% improvement in at least one of the following tests: the Timed 25-Foot-Walk (T25FW), the 2-min walk test (2MWT) and the Multiple Sclerosis Walking Scale (MSWS-12). Eighty-three patients (74%) were found to be responders. The response rate was lower when assessed as a 20% improvement in the T25FW (50.9%), and this difference was particularly marked for fast-walking subjects (i.e. T25FW <8 s at baseline). Responders displayed mean improvements (at D14 and M3, respectively) of 34.5 and 35.5% in the T25FW, 39 and 36.7% in the 2MWT and 19 and 11.6% in the MSWS-12. The increase in gait velocity was due to both a higher cadence and a greater step length. Responders showed also significant, lasting reductions in fatigue (visual analogue scale and the Fatigue Severity Scale; p < 10(-4) at D14 and <0.01 at M3) and significant, lasting improvements in hand function (9 Hole Peg Test; p < 0.05) and QoL (SF-12; p < 0.01). In conclusion, several MS-induced symptoms other than gait velocity may be improved by fampridine-SR, even if this remains to be more specifically evaluated in future studies.