Cortical Excitability Measures May Predict Clinical Response to Fampridine in Patients with Multiple Sclerosis and Gait Impairment
Autor: | Naji Riachi, Samar S. Ayache, Joumana Freiha, Rechdi Ahdab, Karim Makhoul, Madiha M. Shatila, Abed Rahman Shatila, Maher Salem, Rody El Nawar, George Khazen, Shaza El Nemr |
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Rok vydání: | 2019 |
Předmět: |
medicine.medical_specialty
short intracortical inhibition medicine.medical_treatment Neurological examination multiple sclerosis Positive correlation Article 03 medical and health sciences 0302 clinical medicine Physical medicine and rehabilitation Medicine In patient 030212 general & internal medicine fampridine medicine.diagnostic_test business.industry General Neuroscience Multiple sclerosis medicine.disease Gait Transcranial magnetic stimulation Gait impairment walking disability business intracortical facilitation 030217 neurology & neurosurgery After treatment |
Zdroj: | Brain Sciences Volume 9 Issue 12 |
ISSN: | 2076-3425 |
DOI: | 10.3390/brainsci9120357 |
Popis: | Background: Most multiple sclerosis (MS) patients will develop walking limitations during the disease. Sustained-release oral fampridine is the only approved drug that will improve gait in a subset of MS patients. Objectives: (1) Evaluate fampridine cortical excitability effect in MS patients with gait disability. (2) Investigate whether cortical excitability changes can predict the therapeutic response to fampridine. Method: This prospective observational study enrolled 20 adult patients with MS and gait impairment planned to receive fampridine 10 mg twice daily for two consecutive weeks. Exclusion criteria included: Recent relapse (< 3 months), modification of disease modifying drugs (< 6 months), or Expanded Disability Status Scale (EDSS) score > 7. Neurological examination, timed 25-foot walk test (T25wt), EDSS, and cortical excitability studies were performed upon inclusion and 14 days after initiation of fampridine. Results: After treatment, the mean improvement of T25wt (&Delta T25wt) was 4.9 s. Significant enhancement of intra-cortical facilitation was observed (139% versus 241%, p = 0.01) following treatment. A positive correlation was found between baseline resting motor threshold (rMT) and both EDSS (r = 0.57 p < 0.01) and &Delta T25wt (r = 0.57, p = 0.01). rMT above 52% of the maximal stimulator output was found to be a good predictor of a favorable response to fampridine (accuracy: 75%). Discussion: Fampridine was found to have a significant modulatory effect on the cerebral cortex, demonstrated by an increase in excitatory intracortical processes as unveiled by paired-pulse transcranial magnetic stimulation. rMT could be useful in selecting patients likely to experience a favorable response to fampridine. |
Databáze: | OpenAIRE |
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