title: Fampridine and real-life walking in multiple sclerosis: Low predictive value of clinical test for habitual short-term changes.
abstract: BACKGROUND
  Fampridine improves walking speed in patients with multiple sclerosis (MS) in performance-based tests. The impact on habitual mobility and its correlation with clinical tests has not been analysed.
  
  
  OBJECTIVE
  To investigate the association between clinical response criteria and habitual mobility in MS patients starting a fampridine treatment.
  
  
  METHODS
  During a four-week baseline-to-treatment study, we assessed in 28 patients (median EDSS 4.75, range 4-6.5) walking tests as the Timed-25-Foot-Walk (T25FW) and mobility questionnaires at day 0, 14 (start of treatment) and 28. Habitual steps and distance per day, total activity and walking speed was measured by accelerometry over four weeks. Beside improvement in real-life mobility, we investigated if such measures differed between non-responders and responders defined by a 20% improvement in clinical tests.
  
  
  RESULTS
  All clinical test, patient reported outcomes and total activity improved significantly (p<0.05). 46% improved (any change >0) in three of four real-life measures. Change of the T25FW predicted only an increase of distance per day. Subjective rating of patients performed better by predicting distance and walking speed changes correctly.
  
  
  CONCLUSIONS
  Fampridine might improve walking in daily life of MS, but clinical tests are weak predictors. Accelerometry opens a new perspective on mobility measurment, but the current data do not show a consistent effect on non-performance based accelerometry outcomes.
authors.affiliation: Institute of Neuroimmunology and MS (INIMS), University Medical Center Hamburg-Eppendorf, Germany; Department of Neurology, University Medical Center Hamburg-Eppendorf, Germany. Electronic address: j.stellmann@uke.de.
authors.forename: Jan-Patrick
authors.initials: JP
authors.lastname: Stellmann
authors.affiliation: Institute of Neuroimmunology and MS (INIMS), University Medical Center Hamburg-Eppendorf, Germany; RehaCentrum Hamburg, Germany.
authors.forename: Midia
authors.initials: M
authors.lastname: Jlussi
authors.affiliation: Sylvia Lawry Centre for Multiple Sclerosis Research - The Human Motion Institute, Munich, Germany.; Trium Analysis Online GmbH, Munich, Germany.
authors.forename: Anneke
authors.initials: A
authors.lastname: Neuhaus
authors.affiliation: Sylvia Lawry Centre for Multiple Sclerosis Research - The Human Motion Institute, Munich, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Lederer
authors.affiliation: Sylvia Lawry Centre for Multiple Sclerosis Research - The Human Motion Institute, Munich, Germany.; Trium Analysis Online GmbH, Munich, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Daumer
authors.affiliation: Institute of Neuroimmunology and MS (INIMS), University Medical Center Hamburg-Eppendorf, Germany; Department of Neurology, University Medical Center Hamburg-Eppendorf, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Heesen
mesh_terms: D015761:4-Aminopyridine / Q000494:pharmacology / Q000627:therapeutic use*; D061725:Accelerometry; D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D004185:Disability Evaluation; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000188:drug therapy* / Q000503:physiopathology*; D026902:Potassium Channel Blockers / Q000494:pharmacology / Q000627:therapeutic use*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D016138:Walking / Q000502:physiology*; D055815:Young Adult
chemical_list: D026902:Potassium Channel Blockers; D015761:4-Aminopyridine
keywords: Fampridine; Habitual walking; Mobility; Multiple sclerosis; Outcome research