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Why patients with multiple sclerosis perceive improvement of gait during treatment with natalizumab?

  • Neurology and Preclinical Neurological Studies - Original Article
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Abstract

Gait impairment is one of the common manifestations of multiple sclerosis (MS) and contributes to a loss of quality of life. Natalizumab, an anti-α4 integrin monoclonal antibody, has been shown to have an effect in treatment of MS, reducing relapses and inflammatory lesions. Aim of our study was to assess how patients perceive gait impairment over the first year of treatment with natalizumab and what is the objective correlate of this change. This is an open-label prospective observational study. Subjective gait evaluation was measured by Multiple Sclerosis Walking Scale-12 (MSWS-12). Objective gait assessment included Timed 25-Foot Walk Test (T25FW) and spatiotemporal parameters of gait measured by a GAITRite instrument during a self-selected speed of walking (normal walk) and a fast speed of walking (fast walk). We analysed data of 50 patients with a relapsing–remitting form of MS, median EDSS 3.5 (range 1.5–5). MSWS-12 score significantly decreased between the baseline and month 12 of treatment (p < 0.001). Walking velocity and step length were significantly improved in Normal walk tests (p < 0.001). During the Fast walk tests, a step length and a double support time of the gait cycle were significantly improved (p = 0.001). Change in MSWS-12 score confirmed the clinically significant improvement of gait in patients with MS treated with natalizumab for 1 year. The analysis of spatiotemporal gait parameters has shown a significant improvement in self-selected gait velocity and step length.

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References

  • Allali G et al (2014) Dual-task assessment in natalizumab-treated multiple sclerosis patients. Eur Neurol 71(5–6):247–251

    Article  CAS  PubMed  Google Scholar 

  • Belachew S et al (2011) Natalizumab induces a rapid improvement of disability status and ambulation after failure of previous therapy in relapsing-remitting multiple sclerosis. Eur J Neurol 18(2):240–245

    Article  CAS  PubMed  Google Scholar 

  • Benedetti MG et al (1999) Gait abnormalities in minimally impaired multiple sclerosis patients. Mult Scler 5(5):363–368

    Article  CAS  PubMed  Google Scholar 

  • Bilney B, Morris M, Webster K (2003) Concurrent related validity of the GAITRite® walkway system for quantification of the spatial and temporal parameters of gait. Gait Posture 17(1):68–74

    Article  PubMed  Google Scholar 

  • Butzkueven H et al (2014) Efficacy and safety of natalizumab in multiple sclerosis: interim observational programme results. J Neurol Neurosurg Psychiatry 85(11):1190–1197

    Article  PubMed  PubMed Central  Google Scholar 

  • Cadavid D, Jurgensen S, Lee S (2013) Impact of natalizumab on ambulatory improvement in secondary progressive and disabled relapsing-remitting multiple sclerosis. PLoS One 8(1):e53297

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Cohen JA et al (2014) The clinical meaning of walking speed as measured by the timed 25-foot walk in patients with multiple sclerosis. JAMA Neurol 71(11):1386–1393

    Article  PubMed  Google Scholar 

  • Comber L, Galvin R, Coote S (2017) Gait deficits in people with multiple sclerosis: a systematic review and meta-analysis. Gait Posture 51:25–35

    Article  PubMed  Google Scholar 

  • Givon U, Zeilig G, Achiron A (2009) Gait analysis in multiple sclerosis: characterization of temporal-spatial parameters using GAITRite functional ambulation system. Gait Posture 29(1):138–142

    Article  PubMed  Google Scholar 

  • Heesen C et al (2008) Patient perception of bodily functions in multiple sclerosis: gait and visual function are the most valuable. Mult Scler 14(7):988–991

    Article  CAS  PubMed  Google Scholar 

  • Hobart JC et al (2003) Measuring the impact of MS on walking ability: the 12-item MS walking scale (MSWS-12). Neurology 60(1):31–36

    Article  CAS  PubMed  Google Scholar 

  • Iaffaldano P et al (2012) Impact of natalizumab on cognitive performances and fatigue in relapsing multiple sclerosis: a prospective, open-label, two years observational study. PLoS One 7(4):e35843

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Kalron A, Givon U (2016) Gait characteristics according to pyramidal, sensory and cerebellar EDSS subcategories in people with multiple sclerosis. J Neurol 263(9):1796–1801

    Article  PubMed  Google Scholar 

  • Kappos L et al (2011) Natalizumab treatment for multiple sclerosis: updated recommendations for patient selection and monitoring. Lancet Neurol 10(8):745–758

    Article  CAS  PubMed  Google Scholar 

  • Kasser SL et al (2014) Exploring physical activity in women with multiple sclerosis: associations with fear of falling and underlying impairments. Am J Phys Med Rehabil 93(6):461–469

    Article  PubMed  Google Scholar 

  • Kaufman M, Moyer D, Norton J (2000) The significant change for the timed 25-foot walk in the multiple sclerosis functional composite. Mult Scler 6(4):286–290

    Article  CAS  PubMed  Google Scholar 

  • Kelleher KJ et al (2010) The characterisation of gait patterns of people with multiple sclerosis. Disabil Rehabil 32(15):1242–1250

    Article  PubMed  Google Scholar 

  • Larocca NG (2011) Impact of walking impairment in multiple sclerosis: perspectives of patients and care partners. Patient 4(3):189–201

    Article  PubMed  Google Scholar 

  • Lizrova Preiningerova J et al (2015) Spatial and temporal characteristics of gait as outcome measures in multiple sclerosis (EDSS 0 to 6.5). J Neuroeng Rehabil 12:14

    Article  PubMed  PubMed Central  Google Scholar 

  • Maki BE (1997) Gait changes in older adults: predictors of falls or indicators of fear? J Am Geriatr Soc 45(3):313–320

    Article  CAS  PubMed  Google Scholar 

  • Martin CL et al (2006) Gait and balance impairment in early multiple sclerosis in the absence of clinical disability. Mult Scler 12(5):620–628

    Article  CAS  PubMed  Google Scholar 

  • McGuigan C, Hutchinson M (2004) Confirming the validity and responsiveness of the multiple sclerosis walking scale-12 (MSWS-12). Neurology 62(11):2103–2105

    Article  CAS  PubMed  Google Scholar 

  • Mehta L et al (2015) Identifying an important change estimate for the multiple sclerosis walking scale-12 (MSWS-12v1) for interpreting clinical trial results. Mult Scler J Exp Transl Clin 1:2055217315596993

    PubMed  PubMed Central  Google Scholar 

  • Motl RW, Snook EM (2008) Confirmation and extension of the validity of the multiple sclerosis walking scale-12 (MSWS-12). J Neurol Sci 268(1–2):69–73

    Article  PubMed  Google Scholar 

  • Motl RW et al (2010) Multiple sclerosis walking scale-12 and oxygen cost of walking. Gait Posture 31(4):506–510

    Article  PubMed  Google Scholar 

  • Motl RW et al (2015) Longitudinal changes in self-reported walking ability in multiple sclerosis. PLoS One 10(5):e0125002

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Novotna K et al (2016) Quantification of gait abnormalities in healthy-looking multiple sclerosis patients (with expanded disability status scale 0–1.5). Eur Neurol 76(3–4):99–104

    Article  PubMed  Google Scholar 

  • O’connor P et al (2014) Long-term safety and effectiveness of natalizumab redosing and treatment in the STRATA MS Study. Neurology 83(1):78–86

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Peterson EW, Cho CC, Finlayson ML (2007) Fear of falling and associated activity curtailment among middle aged and older adults with multiple sclerosis. Mult Scler J 13(9):1168–1175

    Article  CAS  Google Scholar 

  • Polman CH et al (2006) A randomized, placebo-controlled trial of natalizumab for relapsing multiple sclerosis. N Engl J Med 354(9):899–910

    Article  CAS  Google Scholar 

  • Sosnoff JJ et al (2011) Quantifying gait impairment in multiple sclerosis using GAITRite technology. Gait Posture 34(1):145–147

    Article  PubMed  Google Scholar 

  • Sosnoff JJ, Sandroff BM, Motl RW (2012) Quantifying gait abnormalities in persons with multiple sclerosis with minimal disability. Gait Posture 36(1):154–156

    Article  PubMed  Google Scholar 

  • Stephenson JJ et al (2012) Impact of natalizumab on patient-reported outcomes in multiple sclerosis: a longitudinal study. Health Qual Life Outcomes 10:155

    Article  PubMed  PubMed Central  Google Scholar 

  • Svenningsson A et al (2013) Natalizumab treatment reduces fatigue in multiple sclerosis. Results from the TYNERGY trial; a study in the real life setting. PLoS One 8(3):e58643

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Voloshyna N et al (2015) Natalizumab improves ambulation in relapsing-remitting multiple sclerosis: results from the prospective TIMER study and a retrospective analysis of AFFIRM. Eur J Neurol 22(3):570–577

    Article  CAS  PubMed  Google Scholar 

  • Wickstrom A et al (2014) Reduced sick leave in multiple sclerosis after one year of natalizumab treatment. A prospective ad hoc analysis of the TYNERGY trial. Mult Scler 20(8):1095–1101

    Article  CAS  PubMed  Google Scholar 

  • Yednock TA et al (1992) Prevention of experimental autoimmune encephalomyelitis by antibodies against α4βl integrin. Nature 356(6364):63

    Article  CAS  PubMed  Google Scholar 

  • Zwibel HL (2009) Contribution of impaired mobility and general symptoms to the burden of multiple sclerosis. Adv Ther 26(12):1043–1057

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

This study was financially supported by a research grant from Biogen and by funds from the Czech Ministry of Education Progress Q2/LF1.

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Authors and Affiliations

  1. Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, Katerinska 30, 12000, Prague 2, Czech Republic

    Klara Novotna, Jan Rusz, Eva Kubala Havrdova & Jana Lizrova Preiningerova

  2. Department of Circuit Theory, Faculty of Electrical Engineering, Czech Technical University in Prague, Prague, Czech Republic

    Jan Rusz

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  1. Klara Novotna
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  2. Jan Rusz
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  3. Eva Kubala Havrdova
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  4. Jana Lizrova Preiningerova
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Correspondence to Klara Novotna.

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Novotna, K., Rusz, J., Kubala Havrdova, E. et al. Why patients with multiple sclerosis perceive improvement of gait during treatment with natalizumab?. J Neural Transm 126, 731–737 (2019). https://doi.org/10.1007/s00702-019-02013-z

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  • DOI: https://doi.org/10.1007/s00702-019-02013-z

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