title: Does Modafinil improve the level of consciousness for people with a prolonged disorder of consciousness? a retrospective pilot study.
abstract: OBJECTIVE
  Modafinil is best known as a sleep regulator among healthy individuals, but studies suggest that it reduces excessive daytime sleepiness in patients with brain injury. This retrospective pilot study evaluated the effectiveness of Modafinil for people with a prolonged disorder of consciousness and whether those with a traumatic brain injury did better than those with a non-traumatic brain injury.
  
  
  METHODS
  Twenty four prolonged disorder of consciousness patients who were prescribed Modafinil, were assessed at least four times both before and during treatment. The Coma Recovery Scale-Revised was used to determine if patients had a disorder of consciousness and the Wessex Head Injury Matrix was used to monitor behavior during baseline and treatment periods. Patients with a traumatic brain injury (N = 12) were compared with those with non-traumatic brain injury (N = 12). A chi-square test with significance at 0.05 was used and when frequencies were below 5 a Fisher's Exact Test was used.
  
  
  RESULTS
  Cognitive improvements were noted in domains of wakefulness, awareness, concentration, tracking and following commands. Significant differences were found for the whole group between baseline and Modafinil (x2=9.80; p = 0.002). Eleven of the 12 traumatic brain injury patients had higher Wessex Head Injury Matrix scores when on Modafinil (x2=8.33, p < 0.004). Six non-traumatic brain injury patients had higher scores with Modafinil, two had lower scores and four showed no change. There was no significant difference in the number of patients showing an increase compared to those showing a decrease (Fisher's exact test p = 0.29).
  
  
  CONCLUSIONS
  Modafinil appears to be beneficial for enhancing cognition in prolonged disorder of consciousness patients. Traumatic brain injury patients benefited more than non-traumatic brain injury patients. Implications for Rehabilitation People with prolonged disorders of consciousness are those in coma, a vegetative state or a minimally conscious state. Sensorimotor and neuromodulations (pharmacological and brain stimulation) are the available treatment strategies to this group. Modafinil promotes attention, concentration and maintains wakefulness in a patient with narcolepsy, obstructive sleep apnea and shift work sleep disorders. In a relatively small sample, this retrospective pilot study shows the effectiveness of Modafinil in conjunction with good care, suitable medications and multidisciplinary rehabilitation in enhancing arousal in prolonged disorders of consciousness patients.
authors: a Occupational Therapy Department , The Raphael Medical Center , Kent , UK.|b Occupational Therapy Department , The National University of Ireland Galway , Galway, UK.
authors: Samira Kashinath
authors: SK
authors: Dhamapurkar
authors: c Neuropsychology Department , The Raphael Medical Centre , Kent , UK.|d Oliver Zangwill Centre , Cambridgeshire , UK.
authors: Barbara A
authors: BA
authors: Wilson
authors: c Neuropsychology Department , The Raphael Medical Centre , Kent , UK.
authors: Anita
authors: A
authors: Rose
authors: e MRC Cognition and Brain Sciences Unit Cambridge , Medical Research Council , Cambridgeshire , UK.
authors: Peter
authors: P
authors: Watson
authors: b Occupational Therapy Department , The National University of Ireland Galway , Galway, UK.
authors: Agnes
authors: A
authors: Shiel
mesh_terms: D000328:Adult; D000368:Aged; D001559:Benzhydryl Compounds / Q000627:therapeutic use*; D000070642:Brain Injuries, Traumatic / Q000188:drug therapy; D003071:Cognition / Q000187:drug effects; D003128:Coma / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D000077408:Modafinil; D018458:Persistent Vegetative State / Q000188:drug therapy*; D010865:Pilot Projects; D012189:Retrospective Studies; D064690:Wakefulness-Promoting Agents / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D001559:Benzhydryl Compounds; D064690:Wakefulness-Promoting Agents; D000077408:Modafinil
keywords: Disorders of consciousness; Modafinil; Wessex head injury matrix; coma recovery scale-revised; neuro-modulation