Using Modafinil to Treat Fatigue in Parkinson Disease

Background: Fatigue is a major nonmotor symptom in Parkinson disease (PD). It is associated with reduced activity and lower quality of life. Objective: To determine if modafinil improves subjective fatigue and physical fatigability in PD. Methods: Nineteen PD patients who reported significant fatigue in the Multidimensional Fatigue Inventory (MFI) participated in this 8-week study. Subjects took their regular medications and were randomly assigned to the treatment group (9 subjects, modafinil 100-mg capsule BID) or placebo group (10 subjects). We used the MFI to measure subjective fatigue and used finger tapping and intermittent force generation to evaluate physical fatigability. Subjects also completed the Epworth Sleepiness Scale (ESS) and the Center of Epidemiological StudyYDepression Scale. Results: There were no significant differences at baseline and at 1 month in finger tapping and ESS between the modafinil and placebo groups. At 2 months, the modafinil group had a higher tapping frequency (P G 0.05), shorter dwell time (P G 0.05), and less fatigability in finger tapping and tended to have lower ESS scores (P G 0.12) than the placebo group. However, there was no difference between groups over time for any dimension of the MFI. Conclusions: This small study demonstrated that although modafinil may be effective in reducing physical fatigability in PD, it did not improve fatigue symptoms.