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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. 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.
Adult, Benzhydryl Compounds/adverse effects, Benzhydryl Compounds/therapeutic use, Central Nervous System Stimulants/therapeutic use, Dose-Response Relationship, Drug, Fatigue/complications, Fatigue/drug therapy, Female, Humans, Male, Middle Aged, Multiple Sclerosis/complications, Neuropsychological Tests, Patient Selection, Psychiatric Status Rating Scales, Questionnaires, Severity of Illness Index, Sleep/drug effects, Stroke/complications, Treatment Outcome, Wakefulness/drug effects
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