Affiliation:
1. Department of Medicine Dow University of Health Sciences Karachi Pakistan
2. Department of Neurological Surgery King Edward Medical University Lahore Pakistan
3. Department of Neurosurgery Neurosurgery Clinic Birgunj Nepal
4. Department of Neurology Weill Cornell Medical College New York New York USA
Abstract
AbstractIntroductionMultiple sclerosis (MS) is a debilitating neurological condition affecting nearly one million people across the United States. Among the most prominent symptoms of the condition are excessive fatigue and daytime sleepiness. Numerous clinical trials have investigated the efficacy of modafinil in addressing fatigue among these patients.ObjectiveThe objective of the present study is to assess the safety and efficacy of modafinil for the treatment of fatigue in MS.MethodologyAn electronic search of PUBMED, ScienceDirect, and Cochrane Central was conducted for articles published from inception to December 2023 using search terms such as “modafinil,” “fatigue,” and “MS.”ResultsSeven studies were included in our analysis. Modafinil leads to a meaningful reduction in fatigue when compared with placebo, as measured by Modified Fatigue Impact Scale [mean difference (MD) = −4.42 [−8.01, −.84]; I2 = 45%; p = .02] and Epworth Sleepiness Scale [MD = −.87 [−1.64, −.10]; I2 = 0%; p = .03]. Modafinil also demonstrated a greater risk of precipitating adverse events (e.g., insomnia, gastrointestinal symptoms) when compared with placebo [RR = 1.30 [1.03, 1.66]; I2 = 0%; p = .03]. In quality‐of‐life assessments, modafinil was associated with overall improvement in well‐being [standardized mean difference = .18 [.01, .35]; I2 = 56%; p = .04].ConclusionThe data indicates that modafinil confers a therapeutic benefit when treating fatigue in patients with MS and improves overall quality of life; however, there is a risk of precipitating adverse events. Ultimately, higher quality of evidence may be required to better inform clinical management.