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Effect of modafinil on subjective fatigue in multiple sclerosis and stroke patients
Andrea Brioschi1, Sandrine Gramigna, Esther Werth
1Department of Neurology, Lausanne University Hospital, Lausanne, Switzerland.
Background:
Modafinil has anecdotal response to neurological fatigue, but such an effect may depend on the type and location of cerebral impairment.
Objectives:
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.
Conclusion:
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.
Insights
Modafinil improved subjective fatigue in multiple sclerosis (MS) and brainstem or diencephalic stroke (BDS) patients, but not cortical stroke (CS) patients. The medication was well-tolerated, though physical activity levels remained unchanged.
Area of Science:
- Neurology
- Pharmacology
Background:
- Modafinil shows anecdotal efficacy for neurological fatigue.
- Fatigue response to modafinil may vary based on the location and type of brain impairment.
Purpose of the Study:
- Compare fatigue in brainstem/diencephalic stroke (BDS), cortical stroke (CS), and multiple sclerosis (MS) patients.
- Evaluate modafinil's tolerability and its effect on subjective fatigue.
- Assess changes in cognition, mood, and somnolence.
Main Methods:
- 14 BDS, 9 CS, and 17 MS patients were enrolled.
- Fatigue severity was measured using the Fatigue Assessment Instrument at baseline, 3 months, and after washout.
- Cognition, mood, somnolence, and physical activity were assessed.
Main Results:
- Modafinil was tolerated by 75% of patients.
- A higher responder rate for modafinil was observed in MS and BDS groups compared to the CS group (p=0.04).
- No significant changes in physical activity were detected via Actiwatch measures.
Conclusions:
- Modafinil appears to improve subjective fatigue in MS and BDS patients.
- Modafinil did not significantly improve fatigue in CS patients.
- Low-dose modafinil was generally well-tolerated across patient groups.
