• Fampyra (Fampridine)
  • Tablet administered twice daily 12 hours apart.
  • Potasium-channel-blocker.
  • It plugs some of the holes in the damaged axons, which stops some of the potassium leakage. This is believed to help electrical impulses to continue travelling along the axons to stimulate the muscles, making it easier to walk.
  • To be eligible for Fampyra, you need to have an Expanded Disability Status Scale (EDSS) score between 4 and 7.
  • Fampyra does not work on everyone. It will only work in about 35% of patients.
  • It works quite quickly usually within 1-4 weeks.
  • Walking assessed prior to taking it and then again after around 2 weeks of treatment.
  • Stop if no improvements.
  • Most side effects were mild and resolved within hours or a few days.
  • Fampyra is now available in Ireland and is reimbursed by the HSE on a ‘responder’ basis. This means the HSE will only pay for the drug for those for whom it is proven to have an effect.
    (Fampyra, Your Questions answered. An information booklet for patients who have been prescribed Fampyra. Biogen Idec International, GmbH October 2014.)

Botulinum Toxin

• Botulinum Toxin is a potent neurotoxin. It is produced by a bacterium called Clostridium Botulinum, which is found in soil. 7 types (serotypes A-G) exist, but it is type A that is used therapeutically to treat focal spasticity (of neurogenic origin). Type A currently exists as trade names Dysport and Botox.
• BT is taken up by the Neuromuscular junction within 12 hours and its clinical effect occurs gradually over 4-7 days. It interferes with neuromuscular synaptic transmission for about 12-16 weeks ie. 3-4 months and causes clinically detectable weakness during this period, sometimes longer.
• Repeat injections generally follow a similar course, ie. minimal adaptation occurs. However occasionally patients may become biologically resistant to BT as a result of antibody formation, especially with frequent large dose injections. This has led to the general advice to avoid repeated injections at less than 3 month intervals.
  (Royal College of Physicians 2009 National Guidelines on Spasticity in Adults: management using botulinum toxin)