Effects of modified-release fampridine on upper limb impairment in patients with Multiple Sclerosis

Simpson, Marion; Leonid, Churilov; Bardsley, Belinda; Joanne, Dimovitis; Heriot, Elise; Carey, Leeanne M.; Macdonell, Richard

doi:10.1016/j.msard.2020.101971

Cited by 9 publications

(8 citation statements)

References 29 publications

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“…paired-pulse TMS protocols. They found that fampridine (10 mg bd, for eight consecutive weeks) did not produce significant changes in upper limb function, fatigue, and neurophysiological parameters (98). Over the last years, various studies have demonstrated that neurophysiology can be helpful in measuring and predicting response to treatment.…”

Section: Neurophysiology For Monitoring the Response To Therapies Formentioning

confidence: 99%

The Potential Role of Neurophysiology in the Management of Multiple Sclerosis-Related Fatigue

et al. 2020

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Fatigue is a very common symptom among people with multiple sclerosis (MS), but its management in clinical practice is limited by the lack of clear evidence about the pathogenic mechanisms, objective tools for diagnosis, and effective pharmacological treatments. In this scenario, neurophysiology could play a decisive role, thanks to its ability to provide objective measures and to explore the peripheral and the central structures of the nervous system. We hereby review and discuss current evidence about the potential role of neurophysiology in the management of MS-related fatigue. In the first part, we describe the use of neurophysiological techniques for exploring the pathogenic mechanisms of fatigue. In the second part, we review the potential application of neurophysiology for monitoring the response to pharmacological therapies. Finally, we show data about the therapeutic implications of neurophysiological techniques based on non-invasive brain stimulation.

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Section: Neurophysiology For Monitoring the Response To Therapies Formentioning

confidence: 99%

The Potential Role of Neurophysiology in the Management of Multiple Sclerosis-Related Fatigue

et al. 2020

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“…Overall, MS has many disabling symptoms with deleterious consequences on employment, social functioning, and quality of life, which range from walking disabilities to cognitive impairment [58]. Although dalfampridine was first approved to treat disability in movement, some clinical trials [19,[21][22][23] have found it exerts effects on other bodily functions, which have attracted wider interest. In this study, we used meta-analysis to obtain a valid conclusion of the effects on dalfampridine on different symptoms.…”

Section: Discussionmentioning

confidence: 99%

“…Three trials [19,21,22] reported results for changes in the 9-HPT following treatment with dalfampridine and placebo. There were in total 107 patients in the dalfampridine test group and 74 patients in the placebo control group.…”

Section: The 9-hole Peg Testmentioning

confidence: 99%

Dalfampridine in the treatment of multiple sclerosis: a meta-analysis of randomised controlled trials

Zhang

Tian

et al. 2021

Orphanet J Rare Dis

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Background Multiple sclerosis (MS) is a chronic illness involving the central nervous system (CNS) that is characterised by inflammation, demyelination, and degenerative changes. Dalfampridine is one of the available treatments for MS symptoms and comorbidities. This meta-analysis aimed to assess the safety and benefits of dalfampridine versus placebo in MS by summarising data deriving from previously published clinical randomised controlled studies (RCTs). Results A total of 9 RCTs were included in this meta-analysis, involving 1691 participants. There were significant differences between dalfampridine and placebo in terms of decreased 12-item Multiple Sclerosis Walking Scale score (weighted mean difference [WMD] = − 3.68, 95% confidence interval [CI] [− 5.55, − 1.80], p = 0.0001), improved response to the timed 25-foot walk test (relative risk [RR] = 2.57, 95% CI [1.04, 6.33], p = 0.04), increased 6-min walk test (WMD = 18.40, 95% CI [1.30, 35.51], p = 0.03), increased 9-Hole Peg Test score (WMD = 1.33, 95% CI [0.60, 2.05], p = 0.0004), and increased Symbol Digit Modalities Test score (WMD = 4.47, 95% CI [3.91, 5.02], p < 0.00001). Significant differences in the incidence of side effects were also observed (RR = 1.12, 95% CI [1.04, 1.21], p = 0.002). Conclusion Dalfampridine exerts positive effects on walking ability, finger dexterity, and cognitive function. Treatment should be administered under the guidance of a physician or pharmacist given the higher incidence of adverse events.

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“…45 However, other clinical trials failed to show that MEPs could be useful to detect changes after treatment with fampridine because it was not associated with any difference in MEP measurements (CMCT, MEP amplitude) of upper limb function. 46 Further objective studies are needed to determine the usefulness of MEPs to evaluate symptomatic drugs in MS.…”

Section: Symptomatic Treatmentsmentioning

confidence: 99%

The Use of Motor-Evoked Potentials in Clinical Trials in Multiple Sclerosis

Fernández¹

2020

Journal of Clinical Neurophysiology

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Summary: Motor-evoked potentials (MEPs) can be used to assess the integrity of the descending corticospinal tract in the laboratory. Evoked potentials (EPs) have been widely used in the past for the diagnosis of multiple sclerosis (MS), but they are now becoming more useful in assessing the prognosis of the disease. Motor-evoked potentials have been included in EP scales that have demonstrated good correlations with clinical disability. Soon after the onset of MS, it is possible to detect an ongoing process of neurodegeneration and axonal loss. Axonal loss is probably responsible for the disability and disease progression that occurs in MS. Given the good correlations of EPs in detecting disease progression in MS, they have been used to monitor the effects of drugs used to treat the disease. Several clinical trials used MEPs as part of their EP evaluation, but MEPs have never been used as a measure of efficacy in clinical trials testing neuroprotective agents, although MEPs could be a very promising tool to measure neuroprotection and remyelination resulting from these drugs. To be used in multicenter clinical trials, MEP readings should be comparable between centers. Standardized multicenter EP assessment with central reading has been demonstrated to be feasible and reliable. Although MEP measurements have been correlated with clinical scores and other measures of neurodegeneration, further validation of MEP amplitude measurements is needed regarding their validity, reliability, and sensitivity before they can be routinely used in clinical drug trials in MS.

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Effects of modified-release fampridine on upper limb impairment in patients with Multiple Sclerosis

Cited by 9 publications

References 29 publications

The Potential Role of Neurophysiology in the Management of Multiple Sclerosis-Related Fatigue

The Potential Role of Neurophysiology in the Management of Multiple Sclerosis-Related Fatigue

Dalfampridine in the treatment of multiple sclerosis: a meta-analysis of randomised controlled trials

The Use of Motor-Evoked Potentials in Clinical Trials in Multiple Sclerosis

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