Evaluating the effects of amantadin, modafinil and acetyl-l-carnitine on fatigue in multiple sclerosis – result of a pilot randomized, blind study

Ledinek, Alenka Horvat; Sajko, Mojca Čižek; Rot, Uroš

doi:10.1016/j.clineuro.2013.09.029

Cited by 69 publications

(65 citation statements)

References 30 publications

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“…In addition, no significant difference emerged between pemoline and placebo. Second, Ledinek et al compared the efficiency of each of amantadine, modafinil and acetyl-L-carnitine compared to placebo [112]. Here, fatigue improvement was obtained following amantadine and modafinil, but only amantadine effects reached significance relative to placebo.…”

Section: Amantadine Hydrochloridementioning

confidence: 94%

Fatigue in multiple sclerosis – Insights into evaluation and management

Ayache

Chalah

2017

Neurophysiologie Clinique/Clinical Neurophysiology

126

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Section: Amantadine Hydrochloridementioning

confidence: 94%

Fatigue in multiple sclerosis – Insights into evaluation and management

Ayache

Chalah

2017

Neurophysiologie Clinique/Clinical Neurophysiology

126

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“…116 In a more recent study, amantadine was compared to modafinil and acetyl-L-carnitine, as well as placebo. 117 The study demonstrated some benefit of amantadine over the other treatment arms at the one month assessment of MFIS score. As the total number of patients was small (n = 60), the evidence strength must be considered weak.…”

Section: Treatment Of Fatiguementioning

confidence: 98%

Fatigue and depression in multiple sclerosis: pharmacological and non-pharmacological interventions

Brenner

Piehl

2016

Acta Neurol Scand

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Multiple sclerosis (MS) is a neuroinflammatory condition with a prominent progressive neurodegenerative facet that typically affects young-or middle-aged adults. Although physical disabilities have been in the foreground by being easier to assess, there is an increasing interest in mental disabilities and psychiatric co-morbidities, which have a disproportionally high impact on important outcome measures such as quality of life and occupational disability. In particular, cognitive impairment, depression and mental fatigue, which mutually interact with each other, seem to be of importance in this context. In recent decades, major efforts have been invested in developing more effective disease modulatory treatments. This has resulted in novel therapeutic options and awareness of the importance of early intervention. In comparison, good quality and adequately powered studies on symptomatic treatments of fatigue and psychiatric co-morbidities in MS are rare, and awareness of treatment options is much lower. We here review the existing evidence base for symptomatic treatment of fatigue and depression in MS patients. With regard to fatigue, off-label prescription of alertness improving drugs is common, in spite of all but absent evidence of efficacy. In contrast, a number of smaller studies suggest that physical exercise and fatigue management courses may have some clinical benefit. Very few studies have addressed the efficacy of antidepressants and non-pharmaceutical interventions specifically in MS patients. Therefore, treatment guidelines largely rely on data from non-MS populations. In the future, there is a strong motive to direct additional resources to the study of these important aspects of MS. K E Y W O R D Scognitive symptoms, depression, fatigue, multiple sclerosis, treatment

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“…A total sample size of 34 was required for a crossover study using previously reported effects of modafinil on fatigue for Parkinson’s disease, 10 multiple sclerosis, 21 and a Cochrane review. 22 Assuming modest participant drop out and study drug compliance, we aimed to recruit 36 participants in total.…”

Section: Methodsmentioning

confidence: 99%

MIDAS (Modafinil in Debilitating Fatigue After Stroke)

Bivard

Lillicrap

Krishnamurthy

et al. 2017

Stroke

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Background and Purpose—This study aimed to assess the efficacy of modafinil, a wakefulness-promoting agent in alleviating post-stroke fatigue ≥3 months after stroke. We hypothesized that 200 mg of modafinil daily for 6 weeks would result in reduced symptoms of fatigue compared with placebo.Methods—This single-center phase 2 trial used a randomized, double-blind, placebo-controlled, crossover design. The key inclusion criterion was a multidimensional fatigue inventory score of ≥60. Patients were randomized to either modafinil or placebo for 6 weeks of therapy, then after a 1 week washout period swapped treatment arms for a second 6 weeks of therapy. The primary outcome was the multidimensional fatigue inventory; secondary outcomes included the Montreal cognitive assessment, the Depression, Anxiety, and Stress Scale (DASS), and the Stroke-Specific Quality of Life (SSQoL) scale. The multidimensional fatigue inventory is a self-administered questionnaire with a range of 0 to 100. Treatment efficacy was assessed using linear regression by estimating within-person, baseline-adjusted differences in mean outcomes after therapy. This trial was registered with the Australian New Zealand Clinical Trials Registry (ACTRN12615000350527).Results—A total of 232 stroke survivors were screened and 36 were randomized. Participants receiving modafinil reported a significant decrease in fatigue (multidimensional fatigue inventory, −7.38; 95% CI, −21.76 to −2.99; P<0.001) and improved quality of life (SSQoL, 11.81; 95% CI, 2.31 to 21.31; P=0.0148) compared with placebo. Montreal cognitive assessment and DASS were not significantly improved with modafinil therapy during the study period (P>0.05).Conclusions—Stroke survivors with nonresolving fatigue reported reduced fatigue and improved quality of life after taking 200 mg daily treatment with modafinil.Clinical Trial Registration—URL: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=368268. Unique identifier: ACTRN12615000350527.

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Evaluating the effects of amantadin, modafinil and acetyl-l-carnitine on fatigue in multiple sclerosis – result of a pilot randomized, blind study

Cited by 69 publications

References 30 publications

Fatigue in multiple sclerosis – Insights into evaluation and management

Fatigue in multiple sclerosis – Insights into evaluation and management

Fatigue and depression in multiple sclerosis: pharmacological and non-pharmacological interventions

MIDAS (Modafinil in Debilitating Fatigue After Stroke)

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