title: Modafinil improves information processing speed and increases energetic resources for orientation of attention in narcoleptics: double-blind, placebo-controlled ERP studies with low-resolution brain electromagnetic tomography (LORETA).
abstract: OBJECTIVE
  Recent neuroimaging studies in narcolepsy discovered significant gray matter loss in the right prefrontal and frontomesial cortex, a critical region for executive processing. In the present study, event-related potential (ERP) low-resolution brain electromagnetic tomography (LORETA) was used to investigate cognition before and after modafinil as compared with placebo.
  
  
  METHODS
  In a double-blind, placebo-controlled cross-over design, 15 patients were treated with a 3-week fixed titration scheme of modafinil and placebo. The Epworth Sleepiness Scale (ESS), Maintenance of Wakefulness Test (MWT) and auditory ERPs (odd-ball paradigm) were obtained before and after the 3 weeks of therapy. Latencies, amplitudes and LORETA sources were determined for standard (N1 and P2) and target (N2 and P300) ERP components.
  
  
  RESULTS
  The ESS score improved significantly from 15.4 (+/- 4.0) under placebo to 10.2 (+/- 4.1) under 400mg modafinil (p=0.004). In the MWT, latency to sleep increased nonsignificantly after modafinil treatment (11.9+/-6.9 versus 13.3+/-7.1 min). In the ERP, N2 and P300 latencies were shortened significantly. While ERP amplitudes showed only minor changes, LORETA revealed increased source strengths: for N1 in the left auditory cortex and for P300 in the medial and right dorsolateral prefrontal cortex.
  
  
  CONCLUSIONS
  LORETA revealed that modafinil improved information processing speed and increased energetic resources in prefrontal cortical regions, which is in agreement with other neuroimaging studies.
authors.affiliation: Department of Neurology, Medical University of Vienna, Währinger Gürtel 18-20, Vienna, Austria. michael.saletu@chello.at
authors.forename: Michael
authors.initials: M
authors.lastname: Saletu
authors.forename: Peter
authors.initials: P
authors.lastname: Anderer
authors.forename: Gerda Maria
authors.initials: GM
authors.lastname: Saletu-Zyhlarz
authors.forename: Magdalena
authors.initials: M
authors.lastname: Mandl
authors.forename: Bernd
authors.initials: B
authors.lastname: Saletu
authors.forename: Josef
authors.initials: J
authors.lastname: Zeitlhofer