Modafinil for Multiple Sclerosis
A study in Europe concluded that Provigil could improve sleep quality and daytime fatigue in mulitple sclerosis patients, and that a lower dose was needed than for people with narcolepsy. Another study seemed to contradict that finding, and showed no benefit to MS patients. A Chinese study found similar results.
Experts debate the definition and pathophysiology of fatigue in multiple sclerosis and there is no real way to quantify fatigue, which is subjective. But everyone agrees it is an important topic for MS patients. Fatigue is the most frequently reported symptom of multiple sclerosis; it limits activity and participation in many areas of life and causes psychological distress.
Fatigue management is based on a comprehensive evaluation of its characteristics and consequences (sometimes with the use of scales such as the Fatigue Severity Scale and the Modified Fatigue Impact Scale), and on the identification of many potential contributing factors (psychological disorders, sleep disturbances, pain, infections and other comorbidities, medications, and deconditioning). Rehabilitative interventions are essential to the treatment of fatigue. Beyond the traditional energy conservation strategies and cooling techniques, several randomized controlled studies have demonstrated the positive impact of aerobic exercise.
Further, multiple sclerosis patients often experience cognitive impairment, which may share a common physiopathological substrate with fatigue. Not much is known about effective strategies for managing cognitive impairment in multiple sclerosis. Small trials with amantadine, pemoline, 4-aminopyridine and 3–4 aminopyridine have provided mainly negative results.
Research: A Spanish study found Modafinil helped multiple sclerosis patients' fatigue and was feasible for regular use.