Modafinil for the Improvement of Patient Outcomes Following Traumatic Brain Injury

| April 1, 2018 | 0 Comments

by Amne Borghol, PharmD, BCPS, BCGP; Michael Aucoin, PharmD; Ifeanyichukwu Onor, PharmD, BCPS; Dana Jamero, PharmD, BCOP; and Fadi Hawawini, DO, CMD 

Drs. Borghol, Onor, and Jamero are with the College of Pharmacy at Xavier University of Louisiana in New Orleans, Louisiana. Dr. Aucoin is with the Woman’s Hospital in Baton Rouge, Louisiana. Dr. Hawawini is with the Geriatric and Extended Care Service at Southeast Louisiana Veterans Health Care System in New Orleans, Louisiana.

Innov Clin Neurosci. 2018;15(3–4):17–23

Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Disclosures: The authors have no conflicts of interest relevant to the content of this article.

Abstract: Objective.  The authors sought to assess the literature evidence on the efficacy of modafinil use in patients with fatigue or excessive daytime sleepiness (EDS) secondary to traumatic brain injury (TBI).

Method of Research. A literature search of Medline and PubMed was performed using the EBSCOhost database. Primary literature, observational studies, meta-analyses, case reports, and systematic reviews were assessed for content regarding modafinil and psychostimulant use in patients with TBI. Of the 23 articles collected, three randomized, controlled studies, three observational studies, one case report, and two systematic reviews gave a description of modafinil use in TBI patients.

Results and Conclusion. Modafinil is a central nervous system stimulant with well-established effectiveness in the treatment of narcolepsy and shift-work sleep disorder. There is conflicting evidence about the benefits of modafinil in the treatment of fatigue and EDS secondary to TBI. One randomized, controlled study states that modafinil does not significantly improve patient wakefulness, while another concludes that modafinil corrects EDS but not fatigue. An observational study provides evidence that modafinil increases alertness in fatigued patients with past medical history of brainstem diencephalic stroke or multiple sclerosis. Modafinil appears to have the potential to improve wakefulness in patients with TBI. A prospective, double-blinded, randomized, crossover trial of modafinil for the management of fatigue in ischemic stroke patients is currently being conducted, and further studies demonstrating consistent results are needed before making a conclusive decision.

Keywords: Traumatic brain injury, TBI, excessive daytime sleep, modafinil, fatigue, stroke, head injury

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Category: Past Articles, Quality of Life, Review

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