Article

Modafinil is best known as a sleep regulator among healthy
individuals, but studies suggest that it reduces excessive daytime sleepiness in
patients with brain injury.
This retrospective pilot study evaluated the
effectiveness of Modafinil for people with a prolonged disorder of consciousness
and whether those with a traumatic brain injury did better than those with a
non-traumatic brain injury. METHOD: Twenty four prolonged disorder of
consciousness patients who were prescribed Modafinil, were assessed at least four
times both before and during treatment. The Coma Recovery Scale-Revised was used
to determine if patients had a disorder of consciousness and the Wessex Head
Injury Matrix was used to monitor behavior during baseline and treatment periods.
Patients with a traumatic brain injury (N = 12) were compared with those with
non-traumatic brain injury (N = 12). A chi-square test with significance at 0.05
was used and when frequencies were below 5 a Fisher's Exact Test was used.
RESULTS: Cognitive improvements were noted in domains of wakefulness, awareness,
concentration, tracking and following commands. Significant differences were
found for the whole group between baseline and Modafinil (x(2 )=( )9.80; p =
0.002). Eleven of the 12 traumatic brain injury patients had higher Wessex Head
Injury Matrix scores when on Modafinil (x(2 )=( )8.33, p < 0.004). Six
non-traumatic brain injury patients had higher scores with Modafinil, two had
lower scores and four showed no change. There was no significant difference in
the number of patients showing an increase compared to those showing a decrease
(Fisher's exact test p = 0.29). CONCLUSION: Modafinil appears to be beneficial
for enhancing cognition in prolonged disorder of consciousness patients.
Traumatic brain injury patients benefited more than non-traumatic brain injury
patients. Implications for Rehabilitation People with prolonged disorders of
consciousness are those in coma, a vegetative state or a minimally conscious
state. Sensorimotor and neuromodulations (pharmacological and brain stimulation)
are the available treatment strategies to this group. Modafinil promotes
attention, concentration and maintains wakefulness in a patient with narcolepsy,
obstructive sleep apnea and shift work sleep disorders. In a relatively small
sample, this retrospective pilot study shows the effectiveness of Modafinil in
conjunction with good care, suitable medications and multidisciplinary
rehabilitation in enhancing arousal in prolonged disorders of consciousness
patients.

Langue : ANGLAIS