Treatment with 4-aminopyridine improves upper limb tremor of a patient with multiple sclerosis: a video case report

Abstract

The reversible potassium channel blocker 4-aminopyridine is effective in the treatment of numerous cerebellar dysfunctions, such as episodic ataxia type 2 and downbeat nystagmus syndrome. In 2011, its sustained release form, dalfampridine, was admitted in Europe for the treatment of walking difficulties in patients with multiple sclerosis (MS).

Here we report the case of a 44-year old patient with a progressive MS whose upper limb tremor was markedly reduced under treatment with 4-aminopyridine, as documented in a Tremor Activities of Daily Living questionnaire and in the 9-Hole Peg test. Hand accelerations decreased in the left hand from 10.9 m/sec² to 2.2 m/sec² and in the right hand from 4.2 m/sec² to 0.9 m/sec².

This case report indicates for the first time that 4-aminopyridine might be effective in the symptomatic treatment of tremor entities in patients with MS. The finding calls for further prospective studies to determine the usefulness of 4-aminopyridine or its sustained-release form dalfampridine in treating patients with tremor and MS.

Keywords

Postural tremor 4-aminopyridine cerebellar ataxia multiple sclerosis case study tremor therapy

Get full access to this article

View all access options for this article.

References

Goodman

Brown

Edwards

. A phase 3 trial of extended release oral dalfampridine in multiple sclerosis. Ann Neurol 2010; 68: 494–502.

Strupp

Kalla

Claassen

. A randomized trial of 4-aminopyridine in EA2 and related familial episodic ataxias. Neurology 2011; 77: 269–275.

Schniepp

Wuehr

Ackl

. 4-aminopyridine improves gait variability in cerebellar ataxia due to CACNA 1A mutation. J Neurol 2011; 258: 1708–1711.

Strupp

Schuler

Krafczyk

. Treatment of downbeat nystagmus with 3,4-diaminopyridine: A placebo-controlled study. Neurology 2003; 61: 165–170.

Feys

D’hooghe

Nagels

. The effect of levetiracetam on tremor severity and functionality in patients with multiple sclerosis. Mult Scler 2009; 15: 371–378.

Naderi

Javadi

Motamedi

. The efficacy of primidone in reducing severe cerebellar tremors in patients with multiple sclerosis. Clin Neuropharmacol 2012; Vol: 1243–1251.

Hassan

Ahlskog

Rodriguez

. Surgical therapy for multiple sclerosis tremor: A 12-year follow-up study. Eur J Neurol 2012; 19: 764–768.

Lorenz

Hagen

Ufer

. No benefit of 3,4-diaminopyridine in essential tremor: A placebo-controlled crossover study. Neurology 2006; 66: 1753–1755.

Alvina

Khodakhah

The therapeutic mode of action of 4-aminopyridine in cerebellar ataxia. J Neurosci 2010; 30: 7258–7268.

10.

Wilms

Sievers

Deuschl

Animal models of tremor. Mov Disord 1999; 14: 557–571.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

6.92 MB