Effect of Fampridine on cognition in patients with multiple sclerosis (MS): a systematic review and meta-analysis

Background: Cognitive impairment (CI) is a disabling complication in patients with multiple sclerosis (MS). Fampridine is used to improve walking abilities in subjects with MS while it is also used for improving cognition, although the results are heterogeneous. Therefore, we aimed to conduct a systematic review and meta-analysis to investigate the effect of fampridine on cognition in patients with MS. Methods: We performed a comprehensive search in PubMed, EMBASE, Scopus, Web of Science, google scholar, and also gray including references of the references and conference abstracts on January 1th 2020. We extracted data regarding the number of participants, first author, publication year, country of origin, age, disease duration, Expanded Disability Status Scale (EDSS), duration of follow up, type of cognition test, and scores before and after the treatment. Results: We identified 4972 studies in the preliminary search. After deduplication, 2607 articles remained. Two researchers screened the title and the abstracts, removing 2590 studies. Finally, 15 studies remained for meta-analysis. The included studies were published between 2013 and 2021, and the most frequent country of origin was Denmark. The mean age of participants of the studies ranged between 39 and 53 years and the mean EDSS ranged between 4 and 5.8, respectively. The SMD (standardized mean difference) of Symbol Digit Modalities Test (SDMT) (after-before treatment) was 0.45(95%CI: 0.06-0.84)(I2=75.3%, p<0.001). The SMD of Paced Auditory Serial Addition Test (PASAT) (after-before treatment) was 0.25 (95%CI: 0.13-0.37) (I2=84.3%, p<0.001) . Conclusions: Fampridine has a significant role in decreasing cognitive impairments is MS patients.