Sunday, 20 January, 2002, 00:33 GMT
A drug normally used to treat excessive sleepiness could help beat the devastating fatigue associated with multiple sclerosis, research suggests.
The drug is usually used to treat narcolepsy, a sleep disorder linked to excessive daytime sleepiness and disturbed sleep at night.
But US trials found it also caused a "highly significant" reduction in the extreme tiredness that is a common symptom of multiple sclerosis (MS).
MS fatigue is not like normal tiredness - experts describe it as "deadening".
It affects up to 90% of patients with MS, and as many as two thirds are estimated to experience fatigue on a daily basis.
MS is a progressive disease of the nervous system, with no known cure, which affects around 85, 000 people in the UK.
In addition to fatigue, patients experience a range of symptoms including loss of vision and motor function, sensory impairment, imbalance, bowel and bladder dysfunction, and sometimes problems related to cognition, memory and personality.
Although many therapies have been developed, few have helped to relieve the symptom of fatigue.
Researchers at the Ohio State University Medical Center and Kaiser Permanente in San Diego decided to look at the narcolepsy drug modafinil.
They compared how MS patients felt after taking two different doses of the drug, 200 and 400 milligrams, with a placebo medication.
Seventy-two patients aged 18 to 65 took part in the study.
Those patients who received a 200 mg dose of the drug once a day showed highly significant improvements, according to three separate ways of measuring fatigue.
It was also found that patients receiving the drug had no worse side effects than those who received the placebo.
The researchers say this is the first time a drug has demonstrated this degree of improvement in treating MS related fatigue in a clinical trial.
'No serious side effects'
Dr Kottil Rammohan, a neurologist at the Ohio State University Medical Center, who led the research, said: "We were very pleased to find that a medication that was effective against narcolepsy was able to treat the fatigue associated with multiple sclerosis."
He added: "It is always exciting to find an effective therapy that is void of serious side effects."
More research will be needed to provide detailed information about the optimum dosage and length of treatment using modafinil.
But Dr Rammohan said he hoped more neurologists would start using the drug.
Alan Thompson, professor of neurology and neurorehabilitation at the Institute of Neurology in Queen Square, speaking on behalf of the MS Society in the UK told BBC News Online: "This a welcome addition to the armoury, but what we do know of the treatment is that it suits some people better than others.
He added: "Fatigue in MS is a very very common symptom. The problem is one that a lot of people would put top of their list of their symptoms.
"MS fatigue is not like tiredness, not the same as you or I would feel. It's a deadening, leadening type of fatigue.
"Anything which ability to alleviate that symptom is very much to be welcomed."
The study is published in the Journal of Neurology, Neurosurgery and Psychiatry.
Contact: Betsy Samuels
Ohio State University
COLUMBUS, Ohio - For the first time, researchers here have found an effective therapy that can alleviate the fatigue often accompanying multiple sclerosis. Many therapies have been developed to treat symptoms of multiple sclerosis, but few have helped, to any degree, the excessive, debilitating fatigue that accompanies other disease symptoms in some patients.
Their study appears today in the Journal of Neurology, Neurosurgery and Psychiatry.
Dr. Kottil W. Rammohan, neurologist at The Ohio State University Medical Center, and his colleagues wondered whether the drug modafinil might be effective in relieving this fatigue. Modafinil is used currently in the treatment of narcolepsy, a disease in which patients experience uncontrolled daytime sleepiness.
"We were very pleased to find that a medication that was effective against narcolepsy was able to treat the fatigue associated with multiple sclerosis."
Two doses of modafinil (200 and 400 mg) were compared against a placebo in 72 patients with multiple sclerosis ranging in age from 18 to 65. It was observed that the 200 mg dose of the drug administered once daily showed highly significant improvement in patients. Three separate instruments of rating fatigue were used, and all three showed concordant response to this drug. No previous drug has been able to show this degree of improvement in treating multiple sclerosis-related fatigue in any previous clinical trial.
"We were very pleased to find that a medication that was effective against narcolepsy was able to treat the fatigue associated with multiple sclerosis," said Rammohan, lead author of the study.
Rammohan's group also looked at the potential side effects associated with this medication and found that they were not greater than those experienced by patients in the study who received a placebo.
"It is always exciting to find an effective therapy that is void of serious side effects," said Rammohan.
Fatigue is one of the most common and disabling symptoms of multiple sclerosis. It affects 75 to 90 percent of patients with the disease. As many as 46 to 66 percent of multiple sclerosis patients experience fatigue on a daily basis.
Rammohan said that more studies are needed to better understand the dosage and length of therapy necessary for patients, but he hopes more neurologists will start using modafinil for the treatment of severe fatigue that often accompanies multiple sclerosis.
Also participating in this study were researchers at Kaiser Permanente in San Diego.
Multiple sclerosis is an unpredictable, progressive disease in which scattered patches of nerve fibers in the brain and spinal cord lose "myelin," their protective covering. Resultant loss of neurological function can manifest with a multitude of symptoms.
In addition to fatigue, patients experience a combination of a number of symptoms that include visual loss, loss of motor function, sensory impairment, imbalance, bowel and bladder dysfunction, and sometimes problems related to cognition, memory and personality. Multiple sclerosis is a common disorder and affects about 350,000 people in the United States, mostly women.
Editor's Note: This story embargoed until Jan. 18, 2002 to coincide with publication of a paper in the Journal of Neurology, Neurosurgery and Psychiatry.