Fampridine in the symptomatic treatment of multiple sclerosis: its importance in improving gait and patient functioning Review article

Abstract

Advances in disease-modifying therapies for multiple sclerosis have not diminished the importance of symptomatic treatment, as many patients continue to experience deficits that impair daily functioning. Gait impairment is among the most important factors contributing to loss of independence, reduced activity, and deterioration in quality of life. Prolonged-release fampridine is a symptomatic treatment indicated to improve walking in adult patients with multiple sclerosis who have walking disability corresponding to an EDSS score of 4–7. Its mechanism of action is related to potassium channel blockade, which enhances conduction in demyelinated axons. The most consistent evidence concerns improvement in short-distance walking performance and in patients’ perceived walking ability. Available clinical trial data indicate that a clinically meaningful improvement in walking may be accompanied by improvements in mobility, the physical impact of multiple sclerosis, and selected measures of quality of life. However, treatment response is heterogeneous; therefore, benefit should be assessed after an initial treatment period, and therapy should be continued only in patients who achieve a clinically meaningful improvement. Fampridine should be used as part of a comprehensive management strategy that includes rehabilitation, treatment of coexisting symptoms, and fall prevention.