This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.
To the Editor:
We read with interest the study by Stankoff et al.1 We have also examined the management of fatigue in multiple sclerosis (MS)2 and have since had the opportunity to use multiple fatigue medications in our patients and observe their putative effects. Clinically, we note that modafinil works well to relieve fatigue in most patients with MS and this has been supported by two pilot trials.3,4
Consequently, the result in the article by Stankoff et al. that modafinil produces no improvement in fatigue was surprising.1 The diagnosis of fatigue in patients with MS is difficult. Depression, which is common in MS,5 as well as cognitive impairment, can produce symptoms in common with fatigue. Many of the questions on the Modified Fatigue Impact Scale (scores 45 on the MFIS were used to define fatigue) are affected by depression, cognitive impairment, or both. Perhaps the interplay of these three symptoms dilutes the effect of modafinil on fatigue as measured by the MFIS.
In addition, it is possible that the unusual dosing regimen in the Stankoff et al. trial may have been a factor in the negative results. Dosing recommendations listed in the PDR are for a daily am dose. Modafinil has a half-life of greater than 15 hours, and it is conceivable that the dosing schedule of the study (am and noon) might have impaired the quality of sleep and resulted in additional daytime fatigue. Although a mid-day dose may be necessary in an occasional patient, the Stankoff et al. study routinely used a BID schedule.
Finally, this study includes patients who were treated with medications for fatigue if those medications were withdrawn at least 14 days prior to randomization. This potentially selects subjects who are refractory to treatment since those who are successful in treating their fatigue …
AAN Members
We have changed the login procedure to improve access between AAN.com and the Neurology journals. If you are experiencing issues, please log out of AAN.com and clear history and cookies. (For instructions by browser, please click the instruction pages below). After clearing, choose preferred Journal and select login for AAN Members. You will be redirected to a login page where you can log in with your AAN ID number and password. When you are returned to the Journal, your name should appear at the top right of the page.
AAN Non-Member Subscribers
Purchase access
Letters: Rapid online correspondence
REQUIREMENTS
You must ensure that your Disclosures have been updated within the previous six months. Please go to our Submission Site to add or update your Disclosure information.
Your co-authors must send a completed Publishing Agreement Form to Neurology Staff (not necessary for the lead/corresponding author as the form below will suffice) before you upload your comment.
If you are responding to a comment that was written about an article you originally authored:
You (and co-authors) do not need to fill out forms or check disclosures as author forms are still valid
and apply to letter.
Submission specifications:
- Submissions must be < 200 words with < 5 references. Reference 1 must be the article on which you are commenting.
- Submissions should not have more than 5 authors. (Exception: original author replies can include all original authors of the article)
- Submit only on articles published within 6 months of issue date.
- Do not be redundant. Read any comments already posted on the article prior to submission.
- Submitted comments are subject to editing and editor review prior to posting.
