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New Study Suggests Dalfampridine May Improve Information Processing Speed in People with MS

July 31, 2019

SUMMARY:
  • Dalfampridine tablets (Ampyra®, Acorda Therapeutics) improved cognition involving information processing speed in a controlled clinical trial  involving 120 people with MS. Ampyra is a symptomatic therapy that is approved by the FDA to improve walking in people with MS.
  • In an accompanying editorial, the authors note that the study provides strong evidence for including dalfampridine as a component of comprehensive treatment and prevention of cognitive changes in MS. They caution that this may not work for every individual, and that it does not show evidence for changes beyond processing speed.
  • The team (Laura De Giglio, PhD, MS Center Sant/Andrea Hospital, Rome, Italy, and colleagues) published their findings in Neurology (Published online July 22, 2019).
 
DETAILS
Background: Dalfampridine (Ampyra®, Acorda Therapeutics) is an oral medication, in tablet form, which blocks tiny pores, or potassium channels, on the surface of nerve fibers. Blocking potassium channels may improve the conduction of nerve signals along nerve fibers whose insulating myelin coating has been damaged by MS. Ampyra is a symptomatic therapy that is approved by the U.S. Food and Drug Administration (FDA) to improve walking in people with MS.
 
Changes in cognitive function are common in MS. One area that can be affected is information processing speed. No therapies are specifically approved by the FDA to treat cognitive impairment in people with MS.
 
The Study: Investigators randomly assigned 120 people with MS to take extended-release dalfampridine 10 mg or inactive placebo by mouth twice daily for 12 weeks. Before and after treatment, participants underwent a battery of cognitive and behavioral tests.
 
Results: Participants treated with dalfampridine improved significantly more than those on placebo on the primary endpoint, a scale measuring processing speed (Symbol Digit Modalities Test). This improvement disappeared 4 weeks after the treatment was stopped, suggesting it was due to the treatment. (The authors note that this is not surprising given the mechanism of action of dalfampridine — blocking potassium channels can occur rapidly and is reversible.) Secondary endpoints showed improvements in cognitive fatigue, but not for some other areas of cognitive impairment.
 
The most common adverse events occurring in the dalfampridine group were spasticity, insomnia, and mood alteration; most were mild. Five participants discontinued treatment because of moderate or severe side effects, which included sleeplessness, postural instability and seizure.
 
The team (Laura De Giglio, PhD, MS Center Sant/Andrea Hospital, Rome, Italy, and colleagues) published their findings in Neurology (Published online July 22, 2019).
 
Conclusions: In an accompanying editorial, James Sumowski, PhD (Icahn School of Medicine at Mount Sinai, NY) and Nils Muhlert, PhD (University of Manchester, UK) note that the study provides strong evidence for including dalfampridine as a component of comprehensive treatment and prevention of cognitive changes in MS. They caution that this may not work for every individual, and that it does not show evidence for improving cognition beyond processing speed.
 
“It is important to take a multipronged approach to treating and preventing cognitive decline in MS, including a focus on healthy lifestyles to support brain maintenance starting from diagnosis onward,” write the editorial authors.
 
Read More
Learn how to maintain cognitive health in MS
 

About Multiple Sclerosis

Multiple sclerosis is an unpredictable, often disabling disease of the central nervous system that disrupts the flow of information within the brain, and between the brain and body. Symptoms range from numbness and tingling to blindness and paralysis. The progress, severity and specific symptoms of MS in any one person cannot yet be predicted, but advances in research and treatment are leading to better understanding and moving us closer to a world free of MS. Most people with MS are diagnosed between the ages of 20 and 50, with at least two to three times more women than men being diagnosed with the disease. MS affects more than 2.3 million people worldwide.

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