Saturday, 3 October 2015

Walking features improve with 4 -aminopyrridine

Keune PM, Cocks AJ, Young WR, Burschka JM, Hansen S, Hofstadt-van Oy U, Oschmann P, Muenssinger J. Dynamic walking features and improved walking performance in multiple sclerosis patients treated with fampridine (4-aminopyridine). BMC Neurol. 2015 ;15(1):171.

BACKGROUND:Impaired walking capacity is a frequent confinement in Multiple Sclerosis (MS). Patients are affected by limitations in coordination, walking speed and the distance they may cover. Also abnormal dynamic walking patterns have been reported, involving continuous deceleration over time. Fampridine (4-aminopyridine), a potassium channel blocker, may improve walking in MS. The objective of the current study was to comprehensively examine dynamic walking characteristics and improved walking capacity in MS patients treated with fampridine.
METHODS:A sample of N = 35 MS patients (EDSS median: 4) underwent an electronic walking examination prior to (Time 1), and during treatment with fampridine (Time 2). Patients walked back and forth a distance of 25 ft for a maximum period of 6 min (6-minute 25-foot-walk). Besides the total distance covered, average speed on the 25-foot distance and on turns was determined separately for each test minute, at Time 1 and Time 2.
RESULTS:Prior to fampridine administration, 27/35 patients (77 %) were able to complete the entire 6 min of walking, while following the administration, 34/35 patients (97 %) managed to walk for 6 min. In this context, walking distance considerably increased and treatment was associated with faster walking and turning across all six test minutes (range of effect sizes: partial eta squared = .34-.72). Importantly, previously reported deceleration across test minutes was consistently observable at Time 1 and Time 2.
DISCUSSION:Fampridine administration is associated with improved walking speed and endurance. Regardless of a treatment effect of fampridine, the previously identified, abnormal dynamic walking feature, i.e. the linear decline in walking speed, may represent a robust feature.
CONCLUSIONS:The dynamic walking feature might hence be considered as a candidate for a new outcome measure in clinical studies involving interventions other than symptomatic treatment, such as immune-modulating medication.




The EDSS is rubbish as a tool to study progression. Will walking be a better outcome?

2 comments:

  1. So, it seems this drug could help to improve walking in those with ms. The trouble is that NICE ruled that fampridine should not be offered in the UK. Why not - is it the cost? (Pardon my ignorance). Are we allowed to know the reason(s). Thanks.

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    Replies
    1. It was not considered cost effective to get approved it has to be less than £30-40,000/QALY but Fampridine as considered to be £160,000/QALY. Expensive symptom control drugs are going to struggle to be cost effective with NICE.

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