Effect of modafinil on subjective fatigue in multiple sclerosis and stroke patients.
BACKGROUND
Modafinil has anecdotal response to neurological fatigue, but such an effect may depend on the type and location of cerebral impairment.


OBJECTIVE
It was the aim of this study to compare fatigue observed in different neurological pathologies, to evaluate the tolerability to modafinil, and to describe changes in subjective fatigue.


METHODS
We enrolled 14 brainstem or diencephalic stroke (BDS) patients, 9 cortical stroke (CS) patients and 17 multiple sclerosis (MS) patients. The Fatigue Assessment Instrument severity scale was performed at baseline, after 3 months of modafinil and after 1 month of washout. Cognition, mood and somnolence were assessed. A subgroup of 14 patients underwent activity measures before and during treatment.


RESULTS
Thirty-one patients completed the study (10 BDS, 9 CS, 12 MS). The responder profile is more frequent in MS than in CS (p = 0.04), and in BDS than in CS patients (p = 0.04). Actiwatch measures showed no changes in activity during, before and after therapy.


CONCLUSIONS
Modafinil was tolerated in 75% of patients at small doses and seemed to improve the severity of fatigue in the MS and BDS groups but not in the CS group. There was no modification in measured physical activity.
Brioschi
Andrea
A
Department of Neurology, Lausanne University Hospital, Lausanne, Switzerland.
Gramigna
Sandrine
S
Werth
Esther
E
Staub
Fabienne
F
Ruffieux
Christiane
C
Bassetti
Claudio
C
Schluep
Myriam
M
Annoni
Jean-Marie
JM
D000328:Adult; D001559:Benzhydryl Compounds / Q000009:adverse effects / Q000627:therapeutic use*; D000697:Central Nervous System Stimulants / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D005221:Fatigue / Q000150:complications* / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D000077408:Modafinil; D009103:Multiple Sclerosis / Q000150:complications*; D009483:Neuropsychological Tests; D018579:Patient Selection; D011569:Psychiatric Status Rating Scales; D012720:Severity of Illness Index; D012890:Sleep / Q000187:drug effects; D020521:Stroke / Q000150:complications*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014851:Wakefulness / Q000187:drug effects
D001559:Benzhydryl Compounds; D000697:Central Nervous System Stimulants; D000077408:Modafinil