Deans' stroke musings: Short- and Long-Term Efficacy of Modafinil at Improving Quality of Life in Stroke Survivors: A Post Hoc Sub Study of the Modafinil in Debilitating Fatigue After Stroke Trial

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Tuesday, May 8, 2018

Short- and Long-Term Efficacy of Modafinil at Improving Quality of Life in Stroke Survivors: A Post Hoc Sub Study of the Modafinil in Debilitating Fatigue After Stroke Trial

And these two earlier were not enough to write a protocol on this? So we had to waste time money and energy because our stroke researchers do not follow research in their chosen field. I blame the senior researchers and mentors for their incompetence in not knowing past research.

Modafinil May Alleviate Poststroke Fatigue Nov. 2015

MIDAS (Modafinil in Debilitating Fatigue After Stroke) April 2017

The latest:

Short- and Long-Term Efficacy of Modafinil at Improving Quality of Life in Stroke Survivors: A Post Hoc Sub Study of the Modafinil in Debilitating Fatigue After Stroke Trial

Thomas P. Lillicrap^1,2*,

Christopher R. Levi^1,2,

Elizabeth Holliday²,

Mark William Parsons^1,2 and

Andrew Bivard^1,2

¹Neurology Department, John Hunter Hospital, Newcastle, NSW, Australia
²Hunter Medical Research Institute, Newcastle, NSW, Australia

Background: The phase-II modafinil in debilitating fatigue after stroke trial demonstrated that modafinil improves fatigue and quality of life in severely fatigued stroke survivors. For this study, we sought to examine the interaction between fatigue and quality of life after stroke and determine whether reducing fatigue resulted in improved quality of life. In addition, we followed up a subset of patients 12-months after the trial to assess the long-term outcomes of modafinil therapy.

Methods: We used linear regression to analyze interaction between baseline fatigue, as measured by the multidimensional fatigue inventory (MFI), and quality of life, as measured by the stroke-specific quality of life scale (SSQoL); and between changes in MFI and SSQoL during treatment. Patients also took part in semi-structured interviews and study assessments 12-months after trial completion to assess long-term patterns of modafinil use, safety and efficacy.

Results: MFI and SSQoL were significantly correlated at baseline (β = −1.975 95% CI −3.082, −0.869, p < 0.001), as were changes in MFI and SSQoL during treatment (β = −1.054 95% CI −1.556, −0.553, p < 0.001). 18 patients agreed to 12-month follow-up, of whom 5 had continued to use modafinil. Patients taking modafinil daily demonstrated sustained improvement of 33–38 points in MFI compared to baseline. Two adverse events were reported and there was no evidence of drug tolerance.

Conclusion: Modafinil appears to be safe and, for at least some patients, effective long-term in fatigued stroke survivors. Alleviating fatigue has a significant relationship with improved quality of life.

Clinical trial registration: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=368268, unique-identifier: ACTRN12615000350527.

Introduction

Approximately 40% of stroke survivors experience debilitating fatigue 3 months or more after their stroke which can negatively impact their quality of life, interfering with their ability to participate in rehabilitation and return to everyday activities such as work and socialization (1). We recently investigated the effectiveness of the wakefulness-promoting agent modafinil in stroke survivors as part of the modafinil in debilitating fatigue after stroke (MIDAS) trial (2). During MIDAS, participants reported a significant decrease in fatigue following 6 weeks of modafinil therapy (200 mg/day) and a concurrent improvement in self-reported quality of life. Following from the success of the MIDAS trial, we sought to identify if there was a significant relationship between the resolution of fatigue and improved quality of life during the trial and follow-up patients 12 months after the trial to identify if the reported improved quality of life was sustained 12 months after completion of trial participation. Although modafinil is not approved for stroke-related fatigue in Australia, it can be prescribed off-label by a neurologist or general practitioner and some patients had made use of this fact to continue taking modafinil at their own expense.