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Open AccessArticle

Cortical Excitability Measures May Predict Clinical Response to Fampridine in Patients with Multiple Sclerosis and Gait Impairment

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Lebanese American University Gilbert and Rose Mary Chagoury School of Medicine, Byblos P.O. Box 36, Lebanon
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Hamidy Medical Center, Tripoli 1300, Lebanon
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Neurology Division, Lebanese American University Medical Center Rizk Hospital, Beirut P.O Box 11-3288, Lebanon
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Makassed General hospital, Beirut P.O. Box 11-6301, Lebanon
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Computer Science and Mathematics Department, Lebanese American University, Byblos P.O. Box 36 , Lebanon
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Service de Physiologie-Explorations Fonctionnelles, Hôpital Henri Mondor, Assistance Publique—Hôpitaux de Paris, 51 avenue de Lattre de Tassigny, 94010 Créteil, France
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EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-Créteil, 94010 Créteil, France
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Author to whom correspondence should be addressed.
Brain Sci. 2019, 9(12), 357; https://doi.org/10.3390/brainsci9120357
Received: 18 October 2019 / Revised: 1 December 2019 / Accepted: 3 December 2019 / Published: 5 December 2019
(This article belongs to the Special Issue Advances in Multiple Sclerosis Research)
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 (ΔT25wt) 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 ΔT25wt (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. View Full-Text
Keywords: short intracortical inhibition; intracortical facilitation; fampridine; multiple sclerosis; walking disability short intracortical inhibition; intracortical facilitation; fampridine; multiple sclerosis; walking disability
MDPI and ACS Style

Ahdab, R.; Shatila, M.M.; Shatila, A.R.; Khazen, G.; Freiha, J.; Salem, M.; Makhoul, K.; El Nawar, R.; El Nemr, S.; Ayache, S.S.; Riachi, N. Cortical Excitability Measures May Predict Clinical Response to Fampridine in Patients with Multiple Sclerosis and Gait Impairment. Brain Sci. 2019, 9, 357.

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