Treatments for balance and walking problems
There are a number of things you can do to try to improve your balance. Some of these you can do with support, while others you can try on your own. 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 well-designed physiotherapy programme can help improve balance. There are different types of exercise that may be useful, including exercises specifically designed to improve balance.
The programme could also include exercises that focus on posture, and the strength and suppleness of your muscles, which could in turn benefit your balance.
There's evidence to suggest that a range of exercise therapies, including yoga, Pilates, t'ai chi, the Feldenkrais Method and the Alexander Technique, along wtih aerobics and outdoor walking, can also help.
Getting out and about
There are things you can do if balance issues have affected your ability to get out and about safely.
You may ﬁnd you need to pay more attention than usual to balancing when you walk and move around. You may ﬁnd it easier if you focus on walking, without doing anything else at the same time (such as talking).
Using a stick or other walking aid at times can also help. Some people ﬁnd it particularly helpful in open spaces, or in unfamiliar places. Your occupational therapist and the Disabled Living Foundation can give you further details about equipment available.
At home - simple adjustments, or perhaps some adaptations, may help if you ﬁnd it difﬁcult to move around your house safely. An occupational therapist can also help you ﬁnd suitable adjustments or adaptations.
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 slow down how fast your disability gets worse. But it does improve symptoms to do with spasticity (muscle stiffness) and walking speed for about one in three people with MS. In people who do well on the drug the improvement in their walking often gets less over time but is still better than if they never took the drug. There are currently no other therapies available that improve walking speed in people with MS.
What further work is being undertaken?
If you have problems with dropped foot (meaning that you can’t lift your foot up properly when you’re walking) you may benefit from a splint or Functional Electrical Stimulation (FES). These devices reduce the impact of the dropped foot, and make walking easier and make it less likely that you will trip or fall.
Think you might be eligible for FES but having trouble accessing it? Download our FES campaigns guide.
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.
In August 2011 Fampyra was granted a conditional licence by the European Medicines Agency (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. In October 2014 the National Institutes for Health and Care Excellence (NICE) decided the drug shouldn't be available on the NHS in England. This was because they didn't see it as cost effective. That means they felt the benefit to people with MS wasn't big enough to be worth the money the drug costs the Health Service. The All Wales Medical Strategy Group (AWMSG) and the Scottish Medicines Consortium made the same decision for Wales and Scotland. But people already getting Fampyra on the NHS before this decision can still have it.
You can get the drug with a private prescription but that could cost nearly £2,500 a year at least. If your GP, MS nurse or neurologist think you need the drug they can ask the NHS locally to pay for it but this usually isn't successful. Fampyra remains a drug that you rarely get free on the NHS.
The MS Society believes if you have MS you should get access to the right treatments at the right time, no matter where you live or what your financial situation is. We will carry on campaigning to make Fampyra available on the NHS across the UK.
Download our guide on how to campaign for access to MS medicines
Take action now for fair access to MS treatments