Treatments for balance and walking problems
There are a number of ways to cope with issues with balance, walking and dizziness. An MS nurse, physiotherapist or occupational therapist can help find the probable causes and the most appropriate way to manage the issues.
Once the problem has been investigated, there are a number of options, including:
- exercise and physiotherapy
- equipment and adaptations
- functional electrical stimulation (FES)
A physiotherapy programme can help improve balance. There could be a range of different exercises that are useful, including exercises specifically to improve balance.
Physiotherapy might also improve your posture, and the strength and suppleness of your muscles, which in turn could benefit your balance.
Yoga, Pilates, T'ai chi and the Alexander Technique are all forms of exercise therapy that people with MS say help them with their balance. Clinical trials have found some benefits from t’ai chi, including improved walking speed. Outdoor walking and aerobics may also help with balance.
Problems with balance can vary from time to time and place to place, so the best tool for the job may also vary.
- A stick - particularly helpful in open spaces, or in unfamiliar places. Folding sticks are widely available from high street chemists and specialist equipment suppliers. Folding it away into a small bag can be handy, especially if you use it only in certain situations. It can also be a good marker to other people that you might need extra time to get around obstacles, or that you might need a seat on the bus.
- Wheeled walking frames – often known simply as a ‘walker’. These can give not only a point of contact for balance, but also a support if you get tired. They come in a range of sizes, often with brakes for the wheels, a seat if you need to rest and a place to carry bags.
Your occupational therapist and the Disabled Living Foundation can give you further details about equipment available.
Find out more about adaptations in the home and at work.
- Treatments for other symptoms - Treatments for other symptoms, such as muscle stiffness or weakness, fatigue, pain or anxiety might also have benefits for your balance.
Some people find functional electrical stimulation (FES) useful as an aid to assist walking.
FES) is a non-invasive device that can help some people with MS to walk by using electrical current to stimulate nerves and move parts of the body.
Think you might be eligible for FES but having trouble accessing it? Download our FES campaigns guide.
Fampyra (also known as Fampridine-PR) is a slow-release oral tablet developed for people with MS to improve walking speed and ability. It is marketed in Europe by Biogen Idec, but owned by Accorda Therapeutics.
It's taken as a tablet by mouth twice a day.
How does it work?
Fampyra is a potassium channel blocker. It blocks potassium channels such as those in nerve fibres. This might improve the transmission of nerve impulses down damaged nerve fibres and therefore improve spasticity and walking ability in people with MS.
Biogen Idec has been granted a conditional license in Europe to market Fampyra for walking speed for people with MS.
Fampyra has been shown to improve walking speed and ability by 25% in nearly 43% of people with MS in recent studies.
What side effects were experienced?
Common side effects from trials involving 240 people include urinary tract infections, insomnia, headache, nausea, dizziness, back pain, fatigue and balance problems. One person also experienced anxiety and one person had a seizure.
How does it compare to current therapies?
Fampyra does not change the progression of MS but does improve symptoms associated with spasticity and walking speed in some people with MS. There are currently no other therapies available that improve walking speed in people with MS.
What further work is being undertaken?
Fampyra has a conditional licence in Europe, and was approved by the FDA on 22 January 2010 for use in the USA (the treatment is known as Ampyra in the USA). There are also two phase 3 trials evaluate Fampyra that have recently been completed:
A phase 3 study involving 268 people who had been enrolled in a previous trial (MS-F203 trial). This was an open-label study where everybody on the trial was treated with Famprya. The study investigated the safety and long-term effectiveness of Fampyra (clinicaltrials.gov identifier: NCT00648908).
A phase 3 extension study involving 212 people who had been enrolled in a previous trial (MS-F204 trial). This was an open-label study where everybody on the trial was treated with Fampyra and the study investigated the safety and long-term effectiveness of Fampyra (clinicaltrials.gov identifier: NCT00649792).
Is Fampyra available?
Fampyra is available in Europe, including the UK, for people with MS who have problems with walking. It is available in the USA under the name ‘Ampyra’.
In August 2011 Fampyra was granted a conditional licence by the EMA for people with MS who have severe walking disability (an EDSS score of between four and seven). A conditional licence is renewed annually and it means that the drug can be prescribed during the course of that year. But it means that Biogen Idec (the company that has marketing rights over Fampyra in the UK) will also need to carry out a further study demonstrating the long-term safety and effectiveness of the drug before Fampyra can be considered for a permanent licence in Europe.
Fampyra was launched in Europe on 3 October 2011, but has not yet been considered by the National Institutes for Health and Clinical Excellence (NICE) which will mean that decisions to fund Fampyra will be made at a local level.
Download our guide on how to campaign for access to MS medicines