BACKGROUND: Dalfampridine extended release (D-ER) improves gait speed in some people with multiple sclerosis (MS), but many patients who take D-ER demonstrate only small improvements of questionable clinical significance. Physical therapy (PT) may augment the treatment effects of D-ER on the nervous system and improve clinical outcomes. This case report describes the successful use of D-ER combined with multicomponent PT in a patient who did not have a clinically important change in gait speed with D-ER alone. METHODS: A 59-year-old woman with a 6-year history of relapsing-remitting MS was prescribed D-ER by her neurologist. After 3 weeks of D-ER therapy (10 mg twice daily), she demonstrated only a 7.1% improvement in the Timed 25-Foot Walk test. She then commenced PT consisting of two 40-minute sessions per week for 6 weeks while continuing D-ER therapy. Training focused on gait, balance, coordination, functional strengthening, and dual-task performance. RESULTS: After 6 weeks of D-ER + PT, she had a further 14.6% improvement in Timed 25-Foot Walk gait speed, for a total improvement of 20.7%, which elevated her above the clinically meaningful threshold of 20%. Similar patterns of improvement were also observed for self-selected gait speed in single- and dual-task conditions. Improvements in fast and dual-task gait speed were retained 3 weeks later. CONCLUSIONS: For this patient, combining PT with D-ER therapy improved gait speed more than the use of D-ER alone. Further investigation of D-ER + PT or PT as an alternative to D-ER in patients with submeaningful medication response is warranted.
BACKGROUND: Dalfampridine extended release (D-ER) improves gait speed in some people with multiple sclerosis (MS), but many patients who take D-ER demonstrate only small improvements of questionable clinical significance. Physical therapy (PT) may augment the treatment effects of D-ER on the nervous system and improve clinical outcomes. This case report describes the successful use of D-ER combined with multicomponent PT in a patient who did not have a clinically important change in gait speed with D-ER alone. METHODS: A 59-year-old woman with a 6-year history of relapsing-remitting MS was prescribed D-ER by her neurologist. After 3 weeks of D-ER therapy (10 mg twice daily), she demonstrated only a 7.1% improvement in the Timed 25-Foot Walk test. She then commenced PT consisting of two 40-minute sessions per week for 6 weeks while continuing D-ER therapy. Training focused on gait, balance, coordination, functional strengthening, and dual-task performance. RESULTS: After 6 weeks of D-ER + PT, she had a further 14.6% improvement in Timed 25-Foot Walk gait speed, for a total improvement of 20.7%, which elevated her above the clinically meaningful threshold of 20%. Similar patterns of improvement were also observed for self-selected gait speed in single- and dual-task conditions. Improvements in fast and dual-task gait speed were retained 3 weeks later. CONCLUSIONS: For this patient, combining PT with D-ER therapy improved gait speed more than the use of D-ER alone. Further investigation of D-ER + PT or PT as an alternative to D-ER in patients with submeaningful medication response is warranted.
Authors: Andrew D Goodman; Theodore R Brown; Keith R Edwards; Lauren B Krupp; Randall T Schapiro; Ron Cohen; Lawrence N Marinucci; Andrew R Blight Journal: Ann Neurol Date: 2010-10 Impact factor: 10.422
Authors: Myla D Goldman; Robert W Motl; John Scagnelli; John H Pula; Jacob J Sosnoff; Diego Cadavid Journal: Neurology Date: 2013-10-30 Impact factor: 9.910
Authors: Amy E Latimer-Cheung; Lara A Pilutti; Audrey L Hicks; Kathleen A Martin Ginis; Alyssa M Fenuta; K Ann MacKibbon; Robert W Motl Journal: Arch Phys Med Rehabil Date: 2013-05-10 Impact factor: 3.966
Authors: A D Goodman; T R Brown; J A Cohen; L B Krupp; R Schapiro; S R Schwid; R Cohen; L N Marinucci; A R Blight Journal: Neurology Date: 2008-07-30 Impact factor: 9.910
Authors: Jodie K Haselkorn; Christina Hughes; Alex Rae-Grant; Lily Jung Henson; Christopher T Bever; Albert C Lo; Theodore R Brown; George H Kraft; Thomas Getchius; Gary Gronseth; Melissa J Armstrong; Pushpa Narayanaswami Journal: Neurology Date: 2015-11-24 Impact factor: 9.910