Open AccessTreatment of internuclear ophthalmoparesis in multiple sclerosis with fampridine: A randomized double‐blind, placebo‐controlled cross‐over trial
Author(s) -
Kanhai Kawita M. S.,
Nij Bijvank Jenny A.,
Wagenaar Yorick L.,
Klaassen Erica S.,
Lim KyoungSoo,
Bergheanu Sandrin C.,
Petzold Axel,
Verma Ajay,
Hesterman Jacob,
Wattjes Mike P.,
Uitdehaag Bernard M. J.,
van Rijn Laurentius J.,
Groeneveld Geert Jan
Publication year - 2019
Publication title -
cns neuroscience and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.403
H-Index - 69
eISSN - 1755-5949
pISSN - 1755-5930
DOI - 10.1111/cns.13096
Subject(s) - saccadic masking , placebo , medicine , multiple sclerosis , randomized controlled trial , anesthesia , physical therapy , ophthalmology , eye movement , psychiatry , alternative medicine , pathology
Summary Aim To examine whether the velocity of saccadic eye movements in internuclear ophthalmoparesis ( INO ) improves with fampridine treatment in patients with multiple sclerosis ( MS ). Methods Randomized, double‐blind, placebo‐controlled, cross‐over trial with fampridine in patients with MS and INO . Horizontal saccades were recorded at baseline and at multiple time points post‐dose. Main outcome measures were the change of peak velocity versional dysconjugacy index ( PV ‐ VDI ) and first‐pass amplitude VDI ( FPA ‐ VDI ). Both parameters were compared between fampridine and placebo using a mixed model analysis of variance taking patients as their own control. Pharmacokinetics was determined by serial blood sampling. Results Thirteen patients had a bilateral and 10 had a unilateral INO . One patient had an INO of abduction (posterior INO of Lutz) and was excluded. Fampridine significantly reduced both PV ‐ VDI (−17.4%, 95% CI : −22.4%, −12.1%; P < 0.0001) and FPA ‐ VDI (−12.5%, 95% CI : −18.9%, −5.5%; P < 0.01). Pharmacokinetics demonstrated that testing coincided with the average t max at 2.08 hours ( SD 45 minutes). The main adverse event reported after administration of fampridine was dizziness (61%). Conclusion Fampridine improves saccadic eye movements due to INO in MS . Treatment response to fampridine may gauge patient selection for inclusion to remyelination strategies in MS using saccadic eye movements as primary outcome measure.