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Medications also have been shown to help with mobility issues in MS.
“The major MS disease modifying therapies have some variable success at slowing disability in the short term, which involves in many cases gait function,” Wallin said.
VA clinicians may prescribe the injectables interferon beta-1a and 1b or glatiramer or the oral medication fingolimod. Two other disease modifying medications, the infusion therapies mitoxantrone and natalizumab, are generally considered second-line therapies because of their side effects, according to the VA website.
Beyond those, “dalfampradine is the major FDA-approved medication that can improve gait function,” Wallin said. The first drug that addresses specific symptoms of MS, “dalfampridine is effective in reducing the 25-foot walk time in approximately 30% of patients who are started on the drug,” he noted. Clinical trials indicate that patients who respond to the drug also might benefit from increased muscle strength in the hip flexors, knee flexors and extensors and ankle dorsi-flexors. Because of the variability in response to the drug, “the VA Criteria for Use mandates that some improvement in walking is demonstrated to continue prescribing this medication,” Wallin noted.
Dalfampridine works primarily by blocking potassium channels, which might become too active in MS. It also might increase neurotransmitter release by enabling greater calcium influx at presynaptic terminals. It is contraindicated for patients with moderate or severe kidney impairment, and patients with mild renal impairment should be monitored because of increased risk of seizures, according to the Food and Drug Administration.
- Prosperini L, Fortuna D, Giannì C, Leonardi L, Marchetti MR, Pozzilli C. Home-Based Balance Training Using the Wii Balance Board: A Randomized, Crossover Pilot Study in Multiple Sclerosis. Neurorehabilitation and Neural Repair. 2013 Mar 11. [Epub ahead of print]
- Pilutti L, et al. "RCT of a behavioral intervention targeting physical activity and symptoms in MS." CMSC-ACTRIMS 2013; Abstract SX23.