Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., Portland, OR 97239, USA. firstname.lastname@example.org
BACKGROUND: Fatigue is a major nonmotor symptom in Parkinson disease (PD). It is associated with reduced activity and lower quality of life.
OBJECTIVE: To determine if modafinil improves subjective fatigue and physical fatigability in PD.
METHODS: Nineteen PD patients who reported significant fatigue in the Multidimensional Fatigue Inventory (MFI) participated in this 8-week study. Subjects took their regular medications and were randomly assigned to the treatment group (9 subjects, modafinil 100-mg capsule BID) or placebo group (10 subjects). We used the MFI to measure subjective fatigue and used finger tapping and intermittent force generation to evaluate physical fatigability. Subjects also completed the Epworth Sleepiness Scale (ESS) and the Center of Epidemiological Study-Depression Scale.
RESULTS: There were no significant differences at baseline and at 1 month in finger tapping and ESS between the modafinil and placebo groups. At 2 months, the modafinil group had a higher tapping frequency (P<0.05), shorter dwell time (P<0.05), and less fatigability in finger tapping and tended to have lower ESS scores (P<0.12) than the placebo group. However, there was no difference between groups over time for any dimension of the MFI
CONCLUSIONS: This small study demonstrated that although modafinil may be effective in reducing physical fatigability in PD, it did not improve fatigue symptoms.
PMID: 19620846 [PubMed - indexed for MEDLINE
I asked Benzi Kluger, MD , neurologist, specialist in the nonmotor symptoms of PD, and Assistant Professor at the Department of Neurology at the University of Colorado at Denver, to comment on this study. His remarks are as follows:
1) I often use modafinil and related medications in patients with fatigue and/or attention problems. It doesn't work in everybody but can be very helpful for some people.
2) Clinical trials are helpful to say what happens to a large group of people but may be less helpful to know what is best for an individual patient.
3) This is a small trial (only 9 people got the real drug and 10 got a placebo). With so few people it would be easy to miss a small to moderate effect. Also, their fatigue measure, the Multidimensional Fatigue Inventory, is probably not the best one to use at is not particularly sensitive to change over time.
4) This article does not change my clinical practice but is a good reminder that we need better drugs and studies to help people with PD and fatigue.