Multiple sclerosis and clinical gait analysis Fampridine short- and long-term Fampridine effects: A systematic review

Abstract

Gait impairment is one of the most common and most disabling symptoms in Persons with Multiple Sclerosis (PwMS). Fampridine (4-aminopyridine), a potassium-channel inhibitor, has demonstrated a positive effect on gait speed in PwMS with a gait disturbance. The effects on gait speed are well established after 14 days of treatment but the long-term effects have not yet been demonstrated. This study reviewed the short- and long-term effects of Fampridine on gait in PwMS. This systematic review was conducted according to the PRISMA statement. Prospective, randomized, controlled and non-randomized studies can be found on MEDLINE, Embase and COCHRANE databases. Studies were considered long-term if treatment exceeded 28 days. This limit was chosen by doubling the treatment efficacy period of 14 days, as determined by the French National Authority for Health. Outcomes of interest were gait parameters after treatment. From the 498 studies identified, 18 (2200 patients) fulfilled all eligibility criteria. Five of these articles reported significant improvement in the Timed 25-Foot Walk (T25FW) test after 14 days of treatment (range: 11.2–34.8%). Only three studies followed-up patients for > 1 year and one of them showed a non-significant 20% improvement in the T25FW. Only one study investigated spatiotemporal gait parameters other than speed (for > 3 months), reporting improved gait cadence (11%) and step length (12.8%). Fampridine seems to improve gait speed in PwMS, in the short and long-term. Further long-term studies are needed on related gait (spatiotemporal, kinematics) and functional parameters.