Highlights
- •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.
Abstract
Objective
Review cases of positive neurologic phenomena initiated or worsened with dalfampridine
in patients with multiple sclerosis.
Background
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.
Methods
We reviewed the medical records of patients who were started on dalfampridine for
activation of positive sensory or motor symptoms.
Results
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.
Conclusions
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.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Multiple Sclerosis and Related DisordersAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- 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
Article info
Publication history
Published online: June 17, 2013
Accepted:
May 19,
2013
Received in revised form:
May 11,
2013
Received:
January 23,
2013
Identification
Copyright
© 2013 Elsevier B.V. Published by Elsevier Inc. All rights reserved.
