A retrospective review was undertaken at Texas Tech University Health Sciences Center regarding the use of modafinil for the treatment of spasticity associated with cerebral palsy. Neurology clinic records were reviewed from January 1, 2000, until October 1, 2001. Thirty pediatric patients with cerebral palsy were identified who were treated empirically with modafinil during this time period. Twenty-three (76%) patients reported diminished spasticity with treatment, which was confirmed by physical examination; these patients had improved joint mobility. Seventeen (56%) patients continued treatment with modafinil by the end of the formal review period (September 30, 2001). Twenty-three percent (seven) of the patients stopped taking modafinil during the study owing to one of the following: decreased sleep time (four), decreased appetite (one), hyperactivity, and irritability (two). Thus, this retrospective review shows a reduction in spasticity from cerebral palsy, with only minor and reversible side effects noted from modafinil. A blinded, crossover study using modafinil for spastic cerebral palsy is planned. (J Child Neurol 2004;19:948—951).
Get full access to this article
View all access options for this article.
References
1.
Hurst DL, Lajara-Nanson W.: Use of modafinil in spastic cerebral palsy. J Child Neurol2002;17:169—172.
2.
Lin JS, Hou Y., Jovet M.: Potential brain neuronal targets for amphetamine-, methylphenidate-, and modafinil-induced wakefulness, evidenced by c-fos immunocytochemistry in the cat. Proc Natl Acad Sci U S A1996;93:14128—14133.
3.
Ferraro L., Antonelli T., Tanganelli S., et al: The vigilance promoting drug modafinil increases extracellular glutamate levels in the medial preoptic area and the posterior hypothalamus of the conscious rat: Prevention by local GABA-A receptor blockade. Neuropsychopharmacology1999;20:346—356.
4.
Simon P., Hémet C., Ramassamy C., et al: Non-amphetaminic mechanism of stimulant locomotor effect of modafinil in mice. Eur Neuropsychopharmacol1995;5:509—514.
5.
Simon P., Hémet C., Costentin J.: Analysis of stimulant locomotor effects of modafinil in various strains of mice and rats. Fundam Clin Pharmacol1996;10:431—435.
6.
Duteil J., Rambert FA, Pessonnier J., et al: Central α1-adrenergic stimulation in relation to the behavior stimulating effect of modafinil; studies with experimental animals. Eur J Pharmacol1990;180:49—58.
7.
Piérard C., Satabin P., Lagarde D., et al: Effects of a vigilance-enhancing drug, modafinil, on rat brain metabolism: A 2D COSY 1H-NMR study. Brain Res1995;693:251—256.
8.
Ferraro L., Antonelli T., O'Connor WT, et al: The effects of modafinil on striatal, pallidal and nigral GABA and glutamate release in the conscious rat: Evidence for a preferential inhibition of striatopallidal GABA transmission. Neurosci Lett1998;253:135—138.
9.
Engber TM, Dennis SA, Jones BE, et al: Brain regional substrates for the actions of the novel wake-promoting agent modafinil in the rat: Comparison with amphetamine. Neuroscience1998;87: 905—911.
10.
Ferraro L., Antonelli T., O'Connor WT, et al: The antinarcoleptic drug modafinil increases glutamate release in the thalamic areas and hippocampus. Neuroreport1997;8:2883—2887.
11.
Rammohan KW, Rosenberg JH, Lynn DJ, et al: Efficacy and safety of modafinil (Provigil®) for the treatment of fatigue in multiple sclerosis: a two centre phase 2 study. J Neurol Neurosurg Psychiatry2002;72:179—183.
12.
Krupp LB, Elkins LE: Fatigue and declines in cognitive functioning in multiple sclerosis. Neurology2000;55:934—939.
13.
Bakshi R., Miletich RS, Kinkel PR, et al: High-resolution fluorodeoxyglucose positron emission tomography shows both global and regional cerebral hypometabolism in multiple sclerosis . J Neuroimaging1998;8:228—234.
14.
Roelcke U., Kappos L., Lechner-Scott J., et al: Reduced glucose metabolism in the frontal cortex and basal ganglia of multiple sclerosis patients with fatigue: A 18F-fluorodeoxyglucose positron emission tomography study. Neurology1997;48:1566—1571.
15.
Moldofsky H. , Broughton RJ, Hill JD: A randomized trial of the long-term continued efficacy and safety of modafinil in narcolepsy. Sleep Med2000;1:109—116.
16.
Broughton RJ , Fleming Jae, George Cfp, et al: Randomized, double-blind, placebo-controlled crossover trial of modafinil in the treatment of excessive daytime sleepiness in narcolepsy. Neurology1997;49:444—451.
17.
US Modafinil in Narcolepsy Multicenter Study Group: Randomized trial of modafinil for the treatment of pathological somnolence in narcolepsy. AnnNeurol1998;43:88—97.
18.
Rugino TA, Copley TC: Effects of modafinil in children with attention-deficit hyperactivity disorder: An open-label study. J Am Acad Child Adolesc Psychiatry2001;40:230—235.
19.
Fox AM, Rieder MJ: Risks and benefits of drugs used in the management of the hyperactive child . Drug Saf1993;9:38—50.
20.
Klein RG, Landa B., Mattes JA, et al: Methylphenidate and growth in hyperactive children: A controlled withdrawal study. Arch Gen Psychiatry1988 ;45:1127—1130.
21.
Schachar RJ , Tannock R., Cunningham C., et al: Behavioral, situational, and temporal effects of treatment of ADHD with methylphenidate. J Am Acad Child Adolesc Psychiatry1997;36: 754—763.
22.
Schertz M., Adesman AR, Alfieri NE, et al: Predictors of weight loss in children with attention deficit hyperactivity disorder treated with stimulant medication. Pediatrics1996;98:763—769.
23.
Milla PJ, Jackson Adm: A controlled trial of baclofen in children with cerebral palsy. J Int Med Res1997;5:398—404.
24.
Gilmartin R. , Bruce D., Storrs B., et al: Intrathecal baclofen for management of spastic cerebral palsy: Multicenter trial. J Child Neurol2000;15:71—77.
25.
Fehlings D. , Rang M., Glazier J., et al: An evaluation of botulinum-A toxin injections to improve upper extremity function in children with hemiplegic cerebral palsy. J Pediatr2000;137:331—337.
26.
Nelson KB: Epidemiology of Cerebral Palsy in the Year 2000. Presented at the 29th Annual Meeting of the Child Neurology Society, St. Louis, MO, October 28, 2000.
27.
Hagberg B., Hagberg G., Olow I., et al: The changing panorama of cerebral palsy in Sweden: VII. Prevalence and origin in the birth year period 1987-90. Acta Paediatr1996;85:954—960.
