Modafinil ameliorates excessive daytime sleepiness after traumatic brain injury

Kaiser, Philippe R; Valko, Philipp O.; Werth, Esther; Thomann, Janine; Meier, Josefine; Stocker, Reto; Bassetti, Claudio L.; Baumann, Christian R.

doi:10.1212/wnl.0b013e3181fd62a2

Cited by 127 publications

(79 citation statements)

References 24 publications

(23 reference statements)

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“…Notably, there is a paucity of data regarding the safety and efficacy of these medications among patients with mTBI. In a prospective, double-blind, randomized, placebo-controlled trial, Kaiser et al [88] found that modafinil significantly improved both subjective and objective measures of sleepiness in patients with TBI. However, it did not reduce subjective fatigue, highlighting the multifactorial nature of daytime sequalae in this population.…”

Section: Hypersomnolencementioning

confidence: 99%

Sleep, Sleep Disorders, and Mild Traumatic Brain Injury. What We Know and What We Need to Know: Findings from a National Working Group

et al. 2016

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Disturbed sleep is one of the most common complaints following traumatic brain injury (TBI) and worsens morbidity and long-term sequelae. Further, sleep and TBI share neurophysiologic underpinnings with direct relevance to recovery from TBI. As such, disturbed sleep and clinical sleep disorders represent modifiable treatment targets to improve outcomes in TBI. This paper presents key findings from a national working group on sleep and TBI, with a specific focus on the testing and development of sleep-related therapeutic interventions for mild TBI (mTBI). First, mTBI and sleep physiology are briefly reviewed. Next, essential empirical and clinical questions and knowledge gaps are addressed. Finally, actionable recommendations are offered to guide active and efficient collaboration between academic, industry, and governmental stakeholders.

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Section: Hypersomnolencementioning

confidence: 99%

Sleep, Sleep Disorders, and Mild Traumatic Brain Injury. What We Know and What We Need to Know: Findings from a National Working Group

et al. 2016

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“…11 Specifically, chronically injured individuals report poorer sleep quality 12 and daytime sleepiness 13 relative to healthy controls. Objective recordings of sleep (via polysomnography [PSG]) demonstrate decreased sleep efficiency (time asleep/time in bed 14 ), increased awakenings 12 , hypersomnia 15 , and sleep stage proportion changes several years post TBI.…”

Section: Sleep Disturbances Following Mild Tbimentioning

confidence: 99%

Mild Traumatic Brain Injury Chronically Impairs Sleep- and Wake-Dependent Emotional Processing

Mantua¹,

Henry

Garskovas

et al. 2017

Sleep

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Study Objectives: A single traumatic brain injury (TBI), even when mild (ie, concussion), can cause lasting consequences. Individuals with a history of chronic (>1-year prior) mild TBI have an increased risk of mood disturbances (eg, depression, suicide). This population also has lingering sleep alterations, including poor sleep quality and changes in sleep stage proportions. Given these sleep deficits, we aimed to test whether sleep-dependent emotional memory consolidation is reduced in this population. We utilized a mild TBI group (3.7 ± 2.9 years post injury) and an uninjured (non-TBI) population. Methods: Participants viewed negative and neutral images both before and after a 12-hour period containing sleep ("Sleep" group) or an equivalent period of time spent awake ("Wake" group). Participants rated images for valence/arousal at both sessions, and memory recognition was tested at session two. Results: The TBI group had less rapid eye movement (REM), longer REM latency, and more sleep complaints. Sleep-dependent memory consolidation of nonemotional images was present in all participants. However, consolidation of negative images was only present in the non-TBI group. A lack of differentiation between the TBI Sleep and Wake groups was due to poor performance in the sleep group and, unexpectedly, enhanced performance in the wake group. Additionally, although the non-TBI participants habituated to negative images over a waking period, the TBI participants did not. Conclusions: We propose disrupted sleep-and wake-dependent emotional processing contributes to poor emotional outcomes following chronic, mild TBI. This work has broad implications, as roughly one-third of the US population will sustain a mild TBI during their lifetime.

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“…4,10,13 It should be noted that our findings are somewhat different from previous treatment results, including modafinil in TBI, in which there was a lack of comparable subjective improvement (ESS) to go along with the presence of significant improvement in the MWT. 4,17 The proposed "anosognosia" toward sleepwake disturbances described in previous studies was not found in our population of TBI. In this study, all patients reported subjective improvement in daytime alertness, including those who received placebo.…”

mentioning

confidence: 55%

Armodafinil for the Treatment of Excessive Sleepiness Associated with Mild or Moderate Closed Traumatic Brain Injury: A 12-Week, Randomized, Double-Blind Study followed by a 12-Month Open-Label Extension

Menn¹,

Yang

Lankford

2014

Journal of Clinical Sleep Medicine

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Objective: To evaluate the effi cacy and tolerability of armodafi nil in patients with excessive sleepiness following mild or moderate closed traumatic brain injury (TBI). S C I E N T I F I C I N V E S T I G A T I O N SE ach year, approximately 1.7 million people in the US experience a traumatic brain injury (TBI), 1 of which 75% are classifi ed as mild in severity.2 Sleep disturbances including obstructive sleep apnea, hypersomnia, insomnia, periodic limb movement, and narcolepsy have all been reported among patients with TBI.3-5 Excessive sleepiness-or the more broad condition of hypersomnia-is particularly common among post acute TBI patients, ranging from 25% to 53% depending on the defi nitions of the condition and assessments employed.4,6-8 This is considerably greater than the rate of excessive sleepiness reported in the general population (4.0% to 20.6%). 9The appreciable effects of sleep disorders on the TBI population are not fully known, although some evidence suggests that they may contribute to cognitive impairment, mood disturbance, and disrupt recovery or rehabilitation. 4,[10][11][12][13] Despite the high prevalence of hypersomnia in the TBI population, the literature is sparse regarding treatment recommendations. Recommended strategies include addressing any underlying medical or psychiatric conditions (e.g., nasal continuous positive

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Modafinil ameliorates excessive daytime sleepiness after traumatic brain injury

Abstract: This study provides Class I evidence that modafinil (100-200 mg daily) improves posttraumatic EDS compared with placebo. This study provides Class I evidence that modafinil (100-200 mg daily) does not improve posttraumatic fatigue compared with placebo.

Cited by 127 publications

References 24 publications

Sleep, Sleep Disorders, and Mild Traumatic Brain Injury. What We Know and What We Need to Know: Findings from a National Working Group

Sleep, Sleep Disorders, and Mild Traumatic Brain Injury. What We Know and What We Need to Know: Findings from a National Working Group

Mild Traumatic Brain Injury Chronically Impairs Sleep- and Wake-Dependent Emotional Processing

Armodafinil for the Treatment of Excessive Sleepiness Associated with Mild or Moderate Closed Traumatic Brain Injury: A 12-Week, Randomized, Double-Blind Study followed by a 12-Month Open-Label Extension

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