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.
Address correspondence to Dr Francois Bethoux, Mellen Center for MS Treatment and Research, Cleveland Clinic Foundation, 9500 Euclid Avenue, Desk U10, Cleveland, OH 44195, firstname.lastname@example.org.
Relationship Disclosure: Dr Bethoux has served as a speaker for Acorda Therapeutics, Allergan, Inc, Biogen Idec, and Medtronic, Inc and serves on scientific advisory boards for Acorda Therapeutic and Merz Pharma. Dr Bethoux serves on the editorial board of International Journal of MS Care, published by The Consortium of MS Centers. Dr Bethoux has received research support from Acorda Therapeutics for studies and clinical trials of dalfampridine; from Innovative Neurotronics, Inc, for a trial of the WalkAide device; and from Merz Pharma for a study of Xeomin.
Unlabeled Use of Products/Investigational Use Disclosure: Dr Bethoux discusses the unlabeled use of benzodiazepines, cannabinoids, and botulinum toxin injections for the treatment of lower extremity spasticity; antiepileptics and tricyclic antidepressants for neuropathic pain; and amantadine, modafinil, and armodafinil for fatigue related to multiple sclerosis.