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Narcolepsy Drug Fights Fatigue in MS Patients

Debilitating symptom most common complaint among those with disease

FRIDAY, Jan. 18, 2002 (HealthDayNews) -- A drug that prevents dozing in narcoleptics reduces the debilitating fatigue that plagues people with multiple sclerosis, says a new study.

Researchers found that modafinil, also known as Provigil, significantly increased energy levels in patients with multiple sclerosis-related fatigue.

Multiple sclerosis (MS) is a degenerative condition in which the body's immune cells attack myelin, a protective insulation surrounding the brain, nerve fibers, and spinal cord. It causes recurrent muscle weakness, paralysis and other symptoms.

Fatigue is a common complaint among patients with MS, affecting as many as 80 percent of people with the disease. It can be severe enough to interfere with daily functions.

"In my experience, it's one of the commonest reasons that people with MS have to stop working," says Dr. Andrew D. Goodman, director of the Multiple Sclerosis Clinic at the University of Rochester School of Medicine and Dentistry.

The fatigue tends to worsen as the day progresses, and heat and humidity can aggravate it. The cause is not clear, and current therapies include physical therapy, psychological counseling and sleep regulation. Patients also learn to take rest breaks and naps, and may rely on energy-saving scooters.

Drugs such as Cylert (pemoline) or Symmetrel (amantadine hydrochloride) are sometimes used, but these medications don't always work and can cause insomnia. In the past, doctors turned to amphetamines, but these carried the risk of abuse.

"There's no ideal treatment available," says Goodman.

However, a study that appears in the February issue of the Journal of Neurology, Neurosurgery and Psychiatry reports that modafinil reduced MS-related fatigue.

Dr. Kottil W. Rammohan led a study of 72 patients with MS, ranging in age from 18 to 65. While one group was randomly assigned to receive a placebo, the rest received either 200 milligrams or 400 milligrams of modafinil a day.

The study found patients who received 200 milligrams of modafinil experienced a dramatic improvement in their fatigue, reporting increased levels of energy and vitality on three separate standardized scales of fatigue.

In other studies, says Rammohan, "neither amantadine nor Cylert was capable of budging those scales, even though the patients reported some subjective improvement."

"[Modafinil] is pretty much the only drug that was capable of showing changes in not one, but three different scales," he says.

While some patients reported headaches while taking modafinil, the drug generally produced few side effects, and it didn't conflict with MS medications.

"Most of our patients were already on Avonex, Betaseron or Copaxone, which are the treatments that we use for MS," adds Rammohan.

Dr. Lauren B. Krupp, co-director of the Multiple Sclerosis Comprehensive Care Center at the Stony Brook University Hospital and Health Sciences Center in Stony Brook, N.Y., calls these findings a dramatic step forward.

"Patients can be very pleasantly surprised when they start the medication because they get so much benefit, and the side effect profile is very good," she says.

Rammohan says that future studies should compare the efficacy of modafinil versus amantadine and Cylert, but he suspects modafinil may become a first-line drug for treating fatigue in MS patients.

Some challenges remain. The drug is expensive, and has not yet received U.S. Food and Drug Administration approval for use in MS-related fatigue. Not every insurance plan will cover it, while others may insist a patient try both amantadine and Cylert before modafinil.

"But if I had MS, it's what I'd be on," says Krupp. "I would tell MS patients to change plans based on it, because fatigue is a very important symptom that, so far, has been very disabling and very difficult to manage."

Goodman adds that just having modafinil as an option is a step forward.

"Fatigue is one of the commonest and often most disabling symptoms, so anything that can improve that, even partially, is a welcome addition to our existing treatment strategies," he says.

What To Do

Find out about the symptoms of MS from the National Multiple Sclerosis Society, the Multiple Sclerosis Association of America or the Multiple Sclerosis Foundation.

SOURCES: Interviews with Kottil W. Rammohan, M.D., associate professor, Department of Neurology, Ohio State University Medical Center, Columbus, Ohio; Lauren B. Krupp, M.D., professor, Department of Neurology, and co-director, Multiple Sclerosis Comprehensive Care Center, Stony Brook University Hospital and Health Sciences Center, Stony Brook, N.Y.; Andrew D. Goodman, M.D., director, Multiple Sclerosis Clinic, and chief of neuroimmunology, associate professor, Department of Neurology, University of Rochester School of Medicine and Dentistry, Rochester, N.Y.; February 2002 Journal of Neurology, Neurosurgery and Psychiatry
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