title: High doses of biotin in chronic progressive multiple sclerosis: a pilot study.
abstract: BACKGROUND
  No drug has been found to have any impact on progressive multiple sclerosis (MS). Biotin is a vitamin acting as a coenzyme for carboxylases involved in key steps of energy metabolism and fatty acids synthesis. Among others, biotin activates acetylCoA carboxylase, a potentially rate-limiting enzyme in myelin synthesis.
  
  
  OBJECTIVE
  The aim of this pilot study is to assess the clinical efficacy and safety of high doses of biotin in patients suffering from progressive MS.
  
  
  METHODS
  Uncontrolled, non-blinded proof of concept study
  
  
  METHODS
  23 consecutive patients with primary and secondary progressive MS originated from three different French MS reference centers were treated with high doses of biotin (100-300mg/day) from 2 to 36 months (mean=9.2 months). Judgement criteria varied according to clinical presentations and included quantitative and qualitative measures.
  
  
  RESULTS
  In four patients with prominent visual impairment related to optic nerve injury, visual acuity improved significantly. Visual evoked potentials in two patients exhibited progressive reappearance of P100 waves, with normalization of latencies in one case. Proton magnetic resonance spectroscopy (H-MRS) in one case showed a progressive normalization of the Choline/Creatine ratio. One patient with left homonymous hemianopia kept on improving from 2 to 16 months following treatment׳s onset. Sixteen patients out of 18 (89%) with prominent spinal cord involvement were considered as improved as confirmed by blinded review of videotaped clinical examination in 9 cases. In all cases improvement was delayed from 2 to 8 months following treatment׳s onset.
  
  
  CONCLUSIONS
  These preliminary data suggest that high doses of biotin might have an impact on disability and progression in progressive MS. Two double-blind placebo-controlled trials are on going.
authors: Neurology Department, AP-HP, Salpêtrière Hospital, Paris, France; Neuro-Metabolic Unit and Reference Center for Lysosomal Diseases, GRC13UPMC, Pierre & Marie Curie University-Paris 6, AP-HP, Salpêtrière Hospital, Paris, France.
authors: Frédéric
authors: F
authors: Sedel
authors: Neurology Department, AP-HP, Salpêtrière Hospital, Paris, France.
authors: Caroline
authors: C
authors: Papeix
authors: Pharmacy of the Pitié-Salpêtrière Hospital, Paris, France.
authors: Agnès
authors: A
authors: Bellanger
authors: Department of Ophthalmology, AP-HP, Salpêtrière Hospital, Paris, France.
authors: Valérie
authors: V
authors: Touitou
authors: Department of Neurology, Pasteur Hospital, Nice, France.
authors: Christine
authors: C
authors: Lebrun-Frenay
authors: Department of Neuroradiology, Pierre & Marie Curie University-Paris 6, Paris, France.
authors: Damien
authors: D
authors: Galanaud
authors: Department of Neurology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France.
authors: Olivier
authors: O
authors: Gout
authors: Neurology Department, AP-HP, Salpêtrière Hospital, Paris, France.
authors: Olivier
authors: O
authors: Lyon-Caen
authors: Neurology Department, CHU de Reims & Faculté de Médecine de Reims, Champagne-Ardennes University, France; Laboratoire de Psychopathologie et de Neuropsychologie, EA 2027 Paris VIII University, Saint Denis, France. Electronic address: atourbah@chu-reims.fr.
authors: Ayman
authors: A
authors: Tourbah
mesh_terms: D000328:Adult; D000368:Aged; D001710:Biotin / Q000008:administration & dosage* / Q000009:adverse effects; D004334:Drug Administration Schedule; D005074:Evoked Potentials, Visual / Q000187:drug effects; D006801:Humans; D009682:Magnetic Resonance Spectroscopy; D008875:Middle Aged; D020528:Multiple Sclerosis, Chronic Progressive / Q000178:diet therapy*; D009901:Optic Nerve Diseases / Q000188:drug therapy; D010865:Pilot Projects; D016896:Treatment Outcome; D014792:Visual Acuity / Q000187:drug effects; D014803:Vitamin B Complex / Q000008:administration & dosage* / Q000009:adverse effects
chemical_list: D014803:Vitamin B Complex; D001710:Biotin
keywords: Biotin; Multiple sclerosis; Optic neuritis; Progressive; Visual evoked potentials