Walking Tall Through MS

Multiple sclerosis patients benefited from dalfampridine in study exploring veterans and walking

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) Along with potential vision problems, stomach issues and speech difficulties, one common effect of the neurological condition multiple sclerosis (MS) is having trouble walking. Researchers behind a new year long study explored the results of a medication aimed at improving walking in people who have MS.

In this new study, the medication dalfampridine-ER (brand name Ampyra) and its effect on physical walking abilities, self-perceived walking abilities and participation in community activities were examined in a group of US Veterans with MS. 

The researchers found that after a year of dalfampridine-ER use, participants' walking endurance scores and self-perceived walking abilities improved.

"Discuss any changes in vision or cognition with a health professional."

According to the authors of the new study, dalfampridine-ER (extended release) has been shown to improve walking in short-term trials of people with MS. However, the researchers wanted to further explore the effectiveness of the medication and its safety over the course of a year. 

"Walking impairment includes slowing of gait as well as loss of endurance and, as a result, a reduced ability to participate in community activities, including home-based activities, social activities, and work," explained the study authors, led by Michelle H. Cameron, MD, of the Oregon Health and Science University and the Portland VA (Department of Veterans Affairs) Medical Center. 

Participants in the study were 39 patients from Portland VA Medical Center who were prescribed dalfampridine-ER for one year, between October 1, 2010 and September 30, 2011.

The average age of participants was 56.5 years old and 82 percent were male. On average, the participants had been living with MS for 19.5 years. Thirty-eight percent had relapsing-remitting MS and 62 percent had progressive MS. 

According to the National MS Society, relapsing-remitting MS is characterized by attacks of worsening symptoms and declining neurologic function, followed by periods of recovery, or remission. In progressive MS, the disease is continuing to worsen over time.

Participants completed a variety of tests throughout the study, including the Timed 25-Foot Walk (T25FW) and the Two-Minute Timed Walk (2MTW). The Multiple Sclerosis Walking Scale-12 (MSWS-12) was also completed, which measures a patient's self-report on perceived walking ability. A higher score on this test represents a greater walking limitation.

Participants also completed a Community Integration Questionnaire (CIQ) which measures social integration through topics like who performs household tasks, how often the patient participates in activities outside the home, if the patient engages in leisure actives alone or with others and questions about work, travel and school. The CIQ is measured from 0 to 29, with a higher score showing more social integration.

Tests and questionnaires were completed at the beginning of the study, six to eight weeks after their treatment began and one year later. Side effects were also tracked. 

Fifteen participants stopped taking dalfampridine-ER during the first several weeks of the study. Eight of these patients reported a perceived lack of effectiveness as their reason for no longer using the medication. The other patients experienced a variety of side effects including dizziness, behavioral changes and insomnia. No severe adverse effects were seen.

At the first follow-up, the study authors reported that all measures improved significantly. The average T25FW time dropped 2.7 seconds, the average 2MTW increased by 41 feet, the average MSWS12 score dropped by 11 points and the average CIQ score increased by 1.2 points.

At the one year mark, measures of walking endurance and self-perceived walking measured higher than at the study's beginning, but did not improve over the initial follow-up. Average 2MTW had increased by 33 feet from baseline and MSWS12 scores had dropped 5.9 points from the baseline. The other items measured did not show a significant difference from original scores.

"Dalfampridine-ER was associated with short-term improvements in walking speed and community participation, and sustained improvements in walking endurance and self-perceived impact of MS on walking for one year," Dr. Cameron and team concluded. "Our study supports the utility of this medication in late MS."

It should be noted that only 17 of the original participants returned for the final assessment. Furthermore, there was no control, or placebo, group to compare the scores against. Further research involving larger numbers of participants should be completed to confirm the findings.

The study was published online October 7 by Multiple Sclerosis Journal

Dr. Cameron reported receiving research funding and consulting fees from Acorda Therapeutics, a biotechnology company that manufactures Ampyra. Another study author reported being employed by Biogen Idec, a biotechnology company that manufactures other multiple sclerosis medication. 

Review Date: 
October 9, 2013
Last Updated:
October 13, 2013