Fampridine for gait imbalance in patients with multiple sclerosis (MS): a systematic review and meta-analysis
Sahar Ghorbanpour1, Sarvenaz Rahimibarghani1, Setareh Rohani1
1Department of Physical Medicine and Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran.
Background:
Gait imbalance is one of the frequent complications in subjects with multiple sclerosis (MS). Fampridine (4-aminopyridine) is a potassium-channel blocker that is administered for gait imbalance in MS. Different studies showed the effects of fampridine on gait status based on various tests in subjects with MS. Some showed significant improvement after treatment, and others did not. So, we designed this systematic review, and meta-analysis to estimate the pooled effects of fampridine on gait status in patients with MS.
Methods:
The main goal is the evaluation of times of different gait test pre and post fampridine treatment. Two independent expert researchers conducted a systematic and comprehensive search in PubMed, Scopus, EMBASE, Web of Science, and Google Scholar and also gray literature, including references of the references and conference abstracts. The search was done on September 16, 2022. Before-after studies trials reporting scores of the walking tests. We extracted data regarding the total number of participants, first author, publication year, country of origin, mean age, Expanded Disability Status Scale (EDSS), and the results of walking tests.
Results:
The literature search revealed 1963 studies; after deleting duplicates, 1098 studies remained. Seventy-seven full texts were evaluated. Finally, 18 studies were included for meta-analysis, while most of them were not placebo-controlled trials. The most frequent country of origin was Germany, and the mean age and EDSS ranged between 44 and 56 years and 4 and 6, respectively. The studies were published between 2013 and 2019. The pooled standardized mean difference (SMD) (after-before) of the MS Walking Scale (MSWS-12) was - 1.97 (95%CI: - 1.7, - 1.03) (I2 = 93.1%, P < 0.001). The pooled SMD (after-before) of the six-minute walk test (6MWT) was 0.49 (95%CI: 0.22, - 0.76) (I2 = 0%, P = 0.7). The pooled SMD (after-before) of T Timed 25-Foot Walk (T25FW) was - 0.99(95%CI: - 1.52, - 0.47) (I2 = 97.5%, P < 0.001).
Conclusion:
This systematic review and meta-analysis show that fampridine improves gait imbalance in patients with MS.
Insights
Fampridine (4-aminopyridine) significantly improves gait imbalance in multiple sclerosis (MS) patients. This meta-analysis confirms its effectiveness across various walking tests, offering a valuable treatment option for MS-related gait disturbances.
Area of Science:
- Neurology
- Rehabilitation Medicine
- Clinical Pharmacology
Background:
- Gait imbalance is a common and debilitating symptom in multiple sclerosis (MS).
- Fampridine (4-aminopyridine), a potassium-channel blocker, is used to treat MS-related gait dysfunction.
- Existing research on fampridine's efficacy presents mixed results, necessitating a comprehensive analysis.
Approach:
- A systematic review and meta-analysis were conducted to evaluate fampridine's impact on gait.
- Searches included major databases (PubMed, Scopus, EMBASE, Web of Science, Google Scholar) and gray literature.
- Data from 18 before-after studies, encompassing gait test results, participant demographics, and Expanded Disability Status Scale (EDSS) scores, were analyzed.
Key Points:
- Pooled analysis of the MS Walking Scale (MSWS-12) showed a significant improvement (SMD: -1.97).
- The Timed 25-Foot Walk (T25FW) also demonstrated significant improvement (SMD: -0.99).
- The Six-Minute Walk Test (6MWT) indicated a positive trend, though not statistically significant in this pooled analysis (SMD: 0.49).
Conclusions:
- Fampridine demonstrates a significant positive effect on improving gait imbalance in patients with multiple sclerosis.
- The findings support fampridine as an effective therapeutic agent for enhancing mobility in MS.
- Further research, potentially including placebo-controlled trials, could further elucidate fampridine's precise benefits.
