Editors' Note

Abstract

Editors' Note: In “Monitoring long-term efficacy of fampridine in gait-impaired patients with multiple sclerosis,” authors Filli et al. showed that prolonged-release fampridine improved walking speed, endurance, and self-perceived ambulatory function in patients with multiple sclerosis (MS). Furthermore, patients showed additional drug responsiveness with long-term treatment. Commenting on the article, Dr. Davis asks whether there is a correlation between increased fampridine responsiveness over time and cotreatment with natalizumab. He notes that 32% of the patients studied were also treated with natalizumab. Since the latter decreases disability in MS, it might increase the conduction safety factor sufficiently to restore impulse conduction in blocked axons and increase the efficacy of fampridine. To address Dr. Davis' comments, authors Filli et al. quantify the long-term responsiveness to fampridine of 6 patients with MS cotreated with natalizumab over a period of 2 years. They did not find an increased benefit with respect to walking function in patients treated with natalizumab vs other study participants. However, the number was small and studies with larger cohorts are needed. The editorial “A model for predicting the growth of unruptured intracranial aneurysms: Beyond fortune telling” addressed the article by Backes et al., “ELAPSS score for prediction of risk of growth of unruptured intracranial aneurysms.” ELAPSS (earlier subarachnoid hemorrhage, location of the aneurysm, age >60 years, population, size of the aneurysm, and shape of the aneurysm) is a tool developed to predict the growth of unruptured aneurysms using a weighted composite of patient- and aneurysm-specific characteristics. Editorialists Ding and Etminan believe that ELAPSS is a useful tool to predict risk of growth of unruptured intracranial aneurysms but that the management strategy for these lesions must be supplemented by numerous patient- and aneurysm-specific characteristics not included in the scoring system. Commenting on the editorial, Dr. Munakomi suggests evaluating the role of computational flow dynamics (CFD) to assess further the aneurysm-specific rupture risk. Dr. Ding agrees that CFD may, in the future, provide valuable insight into the rupture risk of unruptured aneurysms, but warns that CFD models require rigorous and prospective validation before they can be applied to clinical decision-making for unruptured aneurysms. —Chafic Karam, MD, and Robert C. Griggs, MD Editors' Note: In “Monitoring long-term efficacy of fampridine in gait-impaired patients with multiple sclerosis,” authors Filli et al. showed that prolonged-release fampridine improved walking speed, endurance, and self-perceived ambulatory function in patients with multiple sclerosis (MS). Furthermore, patients showed additional drug responsiveness with long-term treatment.