- •77 MS patients were started on dalfampridine.
- •Four of 77 patients (5.3%) experienced positive sensory symptoms within 4 weeks.
- •Two patients had recurrent trigeminal neuralgia requiring additional interventions.
- •One patient developed new-onset seizure after seven doses of dalfampridine.
Review cases of positive neurologic phenomena initiated or worsened with dalfampridine in patients with multiple sclerosis.
Oral, extended release dalfampridine (4-aminopyridine or 4-AP) is a potassium-channel blocker approved for the treatment of gait impairment in multiple sclerosis (MS). The enhanced conduction along demyelinated axons promoted by dalfampridine could potentially lead to development of positive neurologic phenomena.
We reviewed the medical records of patients who were started on dalfampridine for activation of positive sensory or motor symptoms.
Four of 76 patients (5.3%) developed positive sensory symptoms within one month of starting dalfampridine; one additional patient had new-onset seizure. Cessation of dalfampridine was insufficient to resolve symptoms in two patients with recurrent trigeminal neuralgia.
Initiation of dalfampridine may be associated with initiation or recurrence of positive sensory symptoms in patients with multiple sclerosis. The increased axonal conduction from potassium channel blockade may contribute to this exacerbation of positive sensory phenomena.
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- Microvascular decompression for trigeminal neuralgia: comments on a series of 250 cases, including 10 patients with multiple sclerosis.Journal of Neurology, Neurosurgery and Psychiatry. 2000; 68: 59-64
Goodman AD, Brown TR. Krupp LB, Schapiro RT, Schwid SR, Cohen R, et al. Sustained release of oral fampridine in multiple sclerosis: a randomized, double-blind, controlled trial. Lancet 2009; 373:732–8
- Practice parameter: The diagnostic evaluation and treatment of trigeminal neuralgia (an evidence-based review).Neurology. 2008; 71: 1183-1190
- Seizures in multiple sclerosis.Epilepsia. 2008; 49: 948-953
- Different effects of 4-aminopyridine on sensory and motor fibers: pathogenesis of paresthesias.Neurology. 1986; 36: 117-120
- Trigeminal neuralgia: Pathology and pathogenesis.Brain. 2001; 124: 2347-2360
- Impaired trigeminal nociceptive processing in patients with trigeminal neuralgia.Neurology. 2007; 69: 835-841
- Percutanous retrogasserian glycerol rhizotomy in the treatment of tic doloreaux associated with multiple sclerosis.Neurosurgery. 2005; 56: 537-545
- The effect of microvascular decompression in patients with multiple sclerosis and trigeminal neuralgia.Neurosurgery. 2010; 67: 749-754
Published online: June 17, 2013
Accepted: May 19, 2013
Received in revised form: May 11, 2013
Received: January 23, 2013
© 2013 Elsevier B.V. Published by Elsevier Inc. All rights reserved.