title: Reduced EDSS progression in multiple sclerosis patients treated with modafinil for three years or more compared to matched untreated subjects.
abstract: BACKGROUND
  Modafinil is a wakefulness-promoting drug used to treat narcolepsy, obstructive sleep apnoea, and shift-work sleep disorder. Modafinil has also been used for the treatment of fatigue and excessive sleepiness in other neurological disorders including multiple sclerosis, psychiatric disorders, and for cognitive enhancement. Recent preclinical studies suggest a potential neuroprotective effect of modafinil in neurodegenerative diseases. Therefore, we investigated its neuroprotective potential in multiple sclerosis.
  
  
  OBJECTIVE
  To retrospectively assess disease progression in a group of MS patients that had received treatment with modafinil, and a matched group that received no treatment with modafinil.
  
  
  METHODS
  We assessed the expanded disability status scale (EDSS) score change, over at least three years, in 30 patients with MS treated with modafinil, and in 90 patients who did not receive modafinil. The two groups were matched for initial EDSS, age, sex, type of disease, disease duration, duration of follow-up, and concomitant disease modifying therapies. Statistical analysis was performed using a general linear regression model.
  
  
  RESULTS
  In relapsing-remitting (RR) patients treated with modafinil there was no significant EDSS change over the follow-up period. In RR patients not treated with modafinil, the mean EDSS increased significantly (0.94; p=0.0001) over the follow-up period. Independent of modafinil treatment status, our model indicated an additional mean EDSS increase of 1.1 point (p=0.0002) for progressive patients i.e. mean EDSS change was 1.1 point for modafinil treated, and 1.1+0.94=2.04 points for modafinil-untreated patients.
  
  
  CONCLUSIONS
  Our results support the hypothesis that modafinil has neuroprotective potential, and may play a role in the treatment of multiple sclerosis. A prospective study will need to confirm this finding.
authors: Academic Division of Clinical Neurology, School of Clinical Sciences, University of Nottingham and Nottingham University Hospital Trust, NG7 2RD Nottingham, UK.
authors: Rashid H
authors: RH
authors: Bibani
authors: Academic Division of Clinical Neurology, School of Clinical Sciences, University of Nottingham and Nottingham University Hospital Trust, NG7 2RD Nottingham, UK.
authors: Christopher R
authors: CR
authors: Tench
authors: Department of Clinical Neurology, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK.
authors: Jithin
authors: J
authors: George
authors: Academic Division of Clinical Neurology, School of Clinical Sciences, University of Nottingham and Nottingham University Hospital Trust, NG7 2RD Nottingham, UK.
authors: Ali
authors: A
authors: Manouchehrinia
authors: Department of Clinical Neurology, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK.
authors: Jacqueline
authors: J
authors: Palace
authors: Academic Division of Clinical Neurology, School of Clinical Sciences, University of Nottingham and Nottingham University Hospital Trust, NG7 2RD Nottingham, UK. Electronic address: Cris.Constantinescu@nottingham.ac.uk.
authors: Cris S
authors: CS
authors: Constantinescu
keywords: Disability; EDSS; Fatigue; Modafinil; Multiple sclerosis; Neuroprotection