Review| Volume 3, ISSUE 1, P17-21, January 2014

Download started.


Sustained-release fampridine in Multiple Sclerosis

  • S. Hadavi
    Blizard Institute, Queen Mary University of London, Barts and the London School of Medicine and Dentistry, London, UK
    Search for articles by this author
  • M.D. Baker
    Blizard Institute, Queen Mary University of London, Barts and the London School of Medicine and Dentistry, London, UK
    Search for articles by this author
  • R. Dobson
    Correspondence to: Blizard Institute, Queen Mary University of London, Barts and the London School of Medicine and Dentistry, 4 Newark Street, London E1 2AT, UK. Tel.: +44 207 882 2285; fax: +44 207 882 2180.
    Blizard Institute, Queen Mary University of London, Barts and the London School of Medicine and Dentistry, London, UK
    Search for articles by this author


      • Fampridine is licensed for the improvement of walking disability in MS patients with an EDSS of 4–7.
      • 30% of patients respond to the drug.
      • Meaningful improvement in both walking speed and patients' subjective perception of their ambulatory deficits is demonstrated using fampridine 10 mg twice-daily.
      • Clinical differentiation of responders from non-responders either by stage of disease or lesion location is not yet possible.
      • Fampridine has an acceptable adverse event profile.


      Sustained-release fampridine, a slow release formulation of 4-aminopryridine, is a voltage-dependent potassium channel blocker licensed for the treatment of walking difficulties in multiple sclerosis (MS). Studies have demonstrated that approximately one-third of MS patients respond with a clear benefit to their walking speed.
      Sustained-release Fampridine is not currently available on the National Health Service (NHS), although it has been approved by the Food and Drug Administration (FDA) in the USA and European Medicine Agency (EMA). It appears to have an acceptable adverse event profile, with data from open-label extension studies now becoming available. Concerns have been raised that the use of fampridine may increase the risk of seizures, which were seen at higher rates in patients treated with high doses of sustained-release fampridine. The rate of seizures in those patients on lower doses has not been found to be significantly increased. There are significant barriers at present to the widespread use of fampridine in the UK, which have limited its use in clinical practice to date.
      Patients with MS are in need of interventions to improve walking and many clinicians feel that this drug may have a role in the symptomatic management of MS.


      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 access
      One-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 to Multiple Sclerosis and Related Disorders
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


      1. Baker, MD. Potential therapeutic mechanism of K+ channel block for MS. Multiple Sclerosis and Related Disorders, 10.1016/j.msard.2013.01.005, in press

        • Bever Jr, CT
        • Young D
        • Anderson PA
        • et al.
        The effects of 4-aminopyridine in multiple sclerosis patients: results of a randomized, placebo-controlled, double-blind, concentration-åcontrolled, crossover trial.
        Neurology. 1994; 44: 1054-1059
        • Chaplin S
        • Dobson R.
        Fampridine for the improvement of walking in multiple sclerosis.
        Prescriber. 2012; 23: 12-16
        • Coles A.
        Multiple sclerosis.
        Practical Neurology. 2009; 9: 118-126
      2. Cuccurullo S. Gait analysis: physical medicine and rehabilitation board review 2004. NCBI bookshelf. Available from: 〈〉; 2012 [accessed 5.07.12].

        • Dalgas U
        • Severinsen K
        • Overgaard K.
        Relations between 6 min walking distance and 10 m walking speed in patients with multiple sclerosis and stroke.
        Archives of Physical Medicine and Rehabilitation. 2012 Jul; 93: 1167-1172
      3. European Medicines Agency. Refusal of the marketing authorisåation for Fampyra (fampridine).; 2013 [accessed 03.03.13].

      4. Food and Drug Administration. NDA: 22–250 Fampridine AC Background.;2013 [accessed 03.03.13].

      5. Food and Drug Administration.;2013 [accessed 03.03.13].

        • Goodman AD
        • Brown TR
        • Cohen JA
        • Krupp LB
        • Schapiro R
        • Schwid SR
        • et al.
        Fampridine MS-F202 Study Group. Dose comparison trial of sustained-release fampridine in multiple sclerosis.
        Neurology. 2008; 71: 1134-1141
        • Goodman AD
        • Brown TR
        • Edwards KR
        • Krupp LB
        • Schapiro RT
        • Cohen R
        • et al.
        MSF204 Investigators. A phase 3 trial of extended release oral dalfampridine in multiple sclerosis.
        Annals of Neurology. 2010; 68: 494-502
        • Goodman AD
        • Brown TR
        • Krupp LB
        • Schapiro RT
        • Schwid SR
        • Cohen R
        • et al.
        Fampridine MS-F203 Investigators. Sustained-release oral fampridine in multiple sclerosis: a randomised, double-blind, controlled trial.
        Lancet. 2009; 373: 732-738
        • Goodman AD
        • Cohen JA
        • Cross A
        • Vollmer T
        • Rizzo M
        • Cohen R
        • et al.
        Fampridine-SR in multiple sclerosis: a randomized, double-blind, placebo-controlled, dose-ranging study.
        Multiple Sclerosis. 2007; 13: 357-368
        • Heesen C
        • Bohm J
        • Reich C
        • Kasper J
        • Goebel M
        • Gold SM.
        Patient perception of bodily functions in multiple sclerosis: gait and visual function are the most valuable.
        Multiple Sclerosis. 2008; 14: 988-991
        • Hersh C
        • Rae-Grant A.
        Extended-release dalfampridine in the management of multiple-sclerosis-related walking impairment.
        Therapeutic Advances in Neurological Disorders. 2012; 5: 199-204
        • Hobart J
        • Lamping D
        • Fitzpatrick R
        • Riazi A
        • Thompson A.
        The Multiple Sclerosis Impact Scale (MSIS-29): a new patient-based outcome measure.
        Brain. 2001; 124: 962-973
        • Koch M
        • Uyttenboogaart M
        • Polman S
        • De Keyser J.
        Seizures in multiple sclerosis.
        Epilepsia. 2008; 49: 948-953
        • Larson RD
        • Larson DJ
        • Baumgartner TB
        • White LJ.
        Repeatability of the timed 25-foot walk test for individuals with multiple sclerosis.
        Clinical Rehabilitation. 2013; ([Epub ahead of print])
        • Murray NM
        • Newsom-Davis J.
        Treatment with oral 4-aminopyridine in disorders of neuromuscular transmission.
        Neurology. 1981; 31: 265-271
      6. NICE. Management of multiple Sclerosis in primary and secondary care. National Institute for Health and Clinical Excellence 2008, London. Available from: 〈〉; 2012 [accessed 5.07.12].

      7. North East Treatment Advisory Group. Fampridine (Fampyra®) in multiple sclerosis. 〈〉;2013 [accessed 03.03.13].

        • Phan-Ba R
        • Calay P
        • Grodent P
        • Delrue G
        • Lommers E
        • Delvaux V
        • et al.
        A corrected version of the Timed-25 Foot Walk Test with a dynamic start to capture the maximum ambulation speed in multiple sclerosis patients.
        Neurorehabilitation. 2012; 30: 261-266
        • Remelius JG
        • Jones SL
        • House JD
        • Busa MA
        • Averill JL
        • Sugumaran K
        • et al.
        Gait impairments in persons with multiple sclerosis across preferred and fixed walking speeds.
        Archives of Physical Medicine and Rehabilitation. 2012; 93: 1637-1642
        • Schwid SR
        • Petrie MD
        • McDermott MP
        • Tierney DS
        • Mason DH
        • Goodman AD.
        Quantitative assessment of sustained-release 4-aminopyridine for symptomatic treatment of multiple sclerosis.
        Neurology. 1997; 48: 817-821
        • Snappin SM
        • Jiang Q.
        Responder analyses and the assessment of a clinically relevant treatment effect.
        Trials. 2007; 8: 31
        • Swingler RJ
        • Compston DA.
        The morbidity of multiple sclerosis.
        Quarterly Journal of Medicine. 1992; 83: 325-337