Gains in walking speed and hand dexterity
Significant improvements were found in spasticity, walking ability and hand dexterity, with no adverse side effects reported.
Building on the results of an earlier study http://www.hspersunite.org.au/dalfampridine-fampyra-may-improve-mobility-in-hsp/, this second study into the use of dalfampridine (Fampyra in Australia) to improve spasticity in HSP produced similar findings. Extended-release dalfampridine improves the walking speed and muscle strength of lower extremities; the slow-release formulation minimizes toxicity and thus increases the utility of the drug in patients with multiple sclerosis (MS) .
The clinical pattern of hereditary spastic paraparesis (HSP) is similar to the spastic gait evident in some patients with MS . The clinical and pathological similarities between HSP and some forms of MS encouraged us to ask whether dalfampridine might aid in the treatment of patients with HSP.
Five consecutive patients with possible HSP were included. Genetic tests confirmed diagnoses of HSP in 4 patients.
Dalfampridine-SR (10mg) was administered twice daily. Data were recorded using the criteria of the Modified Ashworth Scale (MAS), 9-hole peg test (NHPT). The 10 and 20m walk tests were videotaped. All assessments were performed just before dalfampridine administration (baseline) and 15 days later (end-of-study).
All patients were females, with a mean age of 35.2 ± 10.8 years (range 22-49 years). Muscle strength did not change between assessments. The baseline mean MAS score was 2.0 ± 0.7, and the end-of-study score was 1.0 ± 0.0 (95% CI 0.122-1.878, p = 0.034).
The time taken to walk 10m decreased significantly (18.3 ± 5.8 vs. 14.6 ± 6.5 s; 95% CI 1.4-5.9, p = 0.014). The mean percentage improvement was 27.8 ± 9.1%. The time taken to walk 20m also tended to decrease, but the difference was not significant (35.8 ± 11.6 vs. 30.5 ± 13.3 s, p = 0.150). The time required to complete the NHPT was reduced from baseline; the difference was significant for the left hand (20.5 ± 2.2 vs. 18.5 ± 2.5 s, p = 0.025) but not for the right (19.4 ± 3.3 vs. 18.2 ± 2.9 s, p = 0.539).
The aim of the HSP treatment is to ameliorate symptoms and to improve strength and balance via physical therapy and rehabilitation. We prescribed 10mg dalfampridine for some patients with HSP.
Patients with HSP, who were administered dalfampridine, exhibited significant improvements in walking ability, spasticity, and hand dexterity, as measured (respectively) by the Timed-25-Foot Walk Test, MAS, and NHPT instruments. This is the second study to explore the efficacy of dalfampridine to treat HSP. Béreau et al.  showed that dalfampridine was effective in 6 of 12 patients.
A principal difference between our study and that of Béreau et al.  is that we compared hand dexterity before and after treatment, and found that the drug significantly improved such dexterity.
The adverse effects of dalfampridine include seizures, dizziness, nausea, and balance disorders . No patient reported any adverse effect of treatment.
In conclusion, dalfampridine may be a safe alternative treatment for patients with HSP who complain of walking impairments; the drug reduced spasticity and improved hand dexterity.
The authors have declared no conflict of interest regarding this article. The author(s) received no specific funding for this work.
SOURCE: Eur Neurol 2016;76:152-153 Vol. 76, No. 3-4, 2016 (DOI:10.1159/000449375)
The Effects of Dalfampridine on Hereditary Spastic Paraparesis
Uygunoglu U. · Gunduz A. · Tutuncu M. · Akalin M.A. · Saip S. · Siva A.
Department of Neurology, Istanbul University, Cerrahpasa School of Medicine, Istanbul, Turkey