Fampridine-SR and Optic Neuritis Recovery

Study Overview
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Brief Summary
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Optic Neuritis (ON) is a condition that occurs in approximately 50% of individuals with relapse remitting MS, and is the presenting event in 15-20% of patients who go on to develop MS. These ON events present with a decline in vision over several days with painful eye movements. The purpose of this study is to collect pilot data on the effect of Fampridine-SR on the recovery of visual function after demyelinating optic neuritis.Our team evaluated a person with ON who had incomplete recovery which was quite bothersome to her. After a one-month treatment course Fampridine SR,her visual functioning improved. Based on this case, we present a unique opportunity to evaluate the potential benefit of Fampridine-SR as a potential treatment for persons who do not fully recover from acute ON.

Detailed Description
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Optic Neuritis (ON) is a condition that occurs in approximately 50% of individuals with relapse remitting MS, and is the presenting event in 15-20% of patients who go on to develop MS. ON usually presents with a decline in vision over several days to weeks with painful eye movements. Fampridine-SR is currently a Health Canada approved medication to treat walking impairment in persons with MS. Some small studies in the past have shown that Fampridine-SR may also have positive effects on visual functioning in those experiencing ON. This study will aim to assess the effect of taking Fampridine-SR for 8 weeks in 20 MS patients with unresolved optic neuritis on measures of visual functioning, and to determine the best measures to use in a future large scale study. The results of this study will also be used to estimate how many participants we will need in the future large scale study.

Official Title
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The Effect of Fampridine-SR on Visual Function in Poorly Recovered Optic Neuritis in Persons With MS

Conditions
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Optic Neuritis

Intervention / Treatment
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* Drug: Fampridine SR


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Have an MS diagnosis, any type Had an acute optic neuritis without full recovery which occurred ≥ one year ago Have a visual acuity in the affected of eye of ≥ 20/40 or Or ≥20 ms difference in VEP between eyes Or ≥ 120 ms VEP in the affected eye Have not received corticosteroids in the last thirty (30) days Medications that could potentially affect the VEP P100 amplitude or may cause drowsiness/difficulty with visual fixation are allowed if there has been no change in dose within 30 days of study enrollment or anytime during the study. These medications include: Benzodiazepines other than every night at bedtime Opioid and opiates other than every night at bedtime Cannabinoid products other than every night at bedtime Have given written informed consent prior to any study related procedure not part of normal medical care, with the understanding that consent may be withdrawn by the subject at any time without prejudice to his/her future medical care Exclusion Criteria: Have another medical condition that could affect the visual outcomes, such as, but not limited to, diabetes retinopathy, glaucoma, cataracts, previous ocular trauma, amblyopia, and optic neuropathy not due to a demyelinating lesion Creatinine clearance ≤ 80 mL/min Has a history of seizures, with the exception of febrile seizure as an infant Taking a medicinal product that is an inhibitor of Organic Cation Transporter 2 (OCT-2)

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 64 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Fampridine-SR<br>Fampridine-SR 10 mg Orally Twice Daily for 8 weeks. | Drug: Fampridine SR<br>* Fampridine-SR 10 mg twice daily for 8 weeks<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Visual Evoked Potentials | Visual evoked potentials (VEPs) measure the occipital cortical response to visual stimuli and are used to detect visual abnormalities. VEPs will be measured at multiple time points to assess any changes in VEPs over the duration of the study. | Measured at baseline, week 8, and week 12 | 
| Change in Visual Acuity | Change in visual acuity will be assessed using the Early Treatment Diabetic Retinopathy Study (ETDRS) charts and standard protocol as it the gold standard for ophthalmology clinical trials using visual acuity as an outcome. Visual acuity will be measured at multiple time points to assess any changes over the duration of the study. | Measured at baseline, week 8, and week 12 | 
| Change in Contrast Sensitivity | Contrast sensitivity or low contrast visual acuity (LCVA) has been found to be a sensitive measure of visual function in demyelinating lesions when focusing on recovery, even in patients with high contrast visual acuity. Contrast sensitivity will be measured at multiple time points to assess any changes over the duration of the study. | Measured at baseline, week 8, and week 12 | 
| Change in Colour Vision | Colour vision is frequently affected in optic neuritis and unlikely to fully recover We will use Ishihara colour plates, a common test to assess colour vision. Colour vision will be measured at multiple time points to assess any changes over the duration of the study. | Measured at baseline, week 8, and week 12 | 
| Change in Visual Fields | Measures of central visual function are important in the evaluation of optic neuritis, because most cases of optic neuritis affect central vision and therefore decrease quality of life. Visual fields will be measured at multiple time points to assess any changes over the duration of the study. | Measured at baseline, week 8, and week 12 | 
| Optical Coherence Tomography | Optical coherence tomography (OCT) is now a ubiquitous technology in the world of MS research, and is an excellent means of imaging the layers of the retina. | Measured at baseline. | 
| Change in 10-Item Neuro-Ophthalmic Supplement total scores | The 10-Item Neuro-Ophthalmic Supplement (NOS-10) has been developed to capture patient-reported outcomes related to visual dysfunction in patients with visual disorders. Total scores will be collected (range 1 to 52). Scores on the NOS-10 will be measured at multiple time points to assess any changes over the duration of the study. | Measured at baseline, week 8, and week 12 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Multiple sclerosis, Optic Neuritis, Fampyra