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Visual P300 latency predicts treatment response to modafinil in patients with narcolepsy
R B Sangal1, J M Sangal, C Belisle
1Sleep Disorders Institute and Sangal Research Foundation, Troy, MI, USA.
Objective:
To evaluate the hypothesis that visual P300 latency (VL) predicts treatment response to modafinil (a new wake-promoting agent) in patients with narcolepsy.
Design:
Comparison of responders and non-responders in a double-blind randomized placebo-controlled trial.
Setting:
Private practice referral sleep disorders center.
Patients:
Twenty one patients with narcolepsy (ages 17-65 years).
Interventions:
Auditory and visual P300 testing using 31 evenly spaced scalp electrodes, and baseline polysomnograms and objective and subjective tests of daytime sleepiness, followed by modafinil treatment for 9 weeks. Polysomnograms and tests of sleepiness were then repeated.
Main Outcome Measure:
The Maintenance of Wakefulness Test (MWT). Response defined as a final MWT > 7.3min (normative sample mean - 3 SD), plus an increase > 1SD based on normative sample (3.6 min) over baseline MWT.
Results:
Non-responders had longer age-adjusted 31-electrode mean VL (448.4 ms vs. 410.8 ms, P = 0.024), and larger auditory P300 amplitude, with no topographical P300 differences. Non-responders and responders did not differ on any other baseline clinical variable. Using a cut-off of 0.5 SE from normal regression constant, shorter age-adjusted VL predicted modafinil response, with specificity of 0.71 and sensitivity of 0.86.
Conclusions:
VL predicts treatment response to modafinil in patients with narcolepsy.
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