Use of modafinil in spastic cerebral palsy.
After an initial patient with cerebral palsy had an apparent dramatic reduction in spasticity when placed on modafinil, a pilot study was undertaken in 10 pediatric patients to confirm or refute the benefit of modafinil in cerebral palsy. Nine of 10 patients completed the 1-month treatment period. The study patients were treated with 50 or 100 mg of modafinil once daily in the morning. An assessment was made at baseline and at 1 month on treatment. All patients had a clinical examination, Modified Ashworth Scale scores (spasticity) determined by a physical therapist, and videotaping of ambulation. In comparing visit 1 (baseline) and visit 2 (on treatment), statistically significant improvement in the modified Ashworth Scale scores was noted in seven of the nine patients completing the study (P = .0080). A blinded review of the videotapes did not show statistically significant differences in ambulation, but the speed (ft/sec) of gait improved in six of the nine patients (P = .0192). In this study, modafinil, a newly released central stimulant for narcolepsy, showed benefit in treating spasticity in patients with cerebral palsy. A second larger, placebo-controlled, double-blinded trial is planned to confirm these initial results and observations. Modafinil appears to benefit spastic cerebral palsy by a yet to be determined mechanism; however, a primary effect of modafinil on brainstem structures is hypothesized to reduce spasticity of central origin.
Hurst
Daniel L
DL
Department of Neuropsychiatry and Behavioral Science, Texas Tech University Health Sciences Center, Lubbock 79430, USA. daniel.hurst@ttmc.ttuhsc.edu
Lajara-Nanson
Walter
W
D000293:Adolescent; D001559:Benzhydryl Compounds / Q000494:pharmacology / Q000627:therapeutic use*; D001835:Body Weight; D000697:Central Nervous System Stimulants / Q000494:pharmacology / Q000627:therapeutic use*; D002547:Cerebral Palsy / Q000188:drug therapy* / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D005500:Follow-Up Studies; D005684:Gait / Q000187:drug effects; D006801:Humans; D008297:Male; D000077408:Modafinil; D026741:Physical Therapy Modalities / Q000379:methods; D014743:Videotape Recording
D001559:Benzhydryl Compounds; D000697:Central Nervous System Stimulants; D000077408:Modafinil