Purpose of Review
Ambulation, and more broadly mobility, is frequently affected by multiple sclerosis (MS). The purpose of this review is to present recent developments regarding the impact, outcome measures, and management of gait disorders in MS.
Recently published surveys have confirmed the high prevalence of walking limitations in MS and their impact on the functional status and quality of life of MS patients and their families. Validated clinical outcome measures include the Timed 25-Foot Walk, 6-Minute Walk, and Multiple Sclerosis Walking Scale-12. Further characterization of gait disorders is allowed by gait analysis systems, as well as pedometers and oscillometers that measure walking in the patient’s daily life. A growing body of evidence demonstrates the benefits of various rehabilitation interventions on walking performance. Dalfampridine, an extended-release formulation of 4-aminopyridine, is the first symptomatic medication indicated to improve walking in patients with MS. Newer assistive devices, such as the hip flexion assist device and functional electrical stimulation devices, show promising results in preliminary studies. Various treatments for spasticity can be used without compromising ambulation, but their ability to enhance gait needs to be further assessed.
Gait disorders need to be identified and managed early in the course of MS, using a multimodal approach that needs to be adjusted over time based on the results of periodic assessments.