Document Type : Original Article
Authors
1 Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
2 Department of Statistics, Isfahan University of Technology, Isfahan, Iran
Abstract
Background: A large percentage of patients with Parkinson's disease (PD) suffer from excessive daytime sleepiness (EDS). This study aims to compare the effectiveness of modafinil and methylphenidate on EDS and side effects.
Methods: Fifty nine patients with PD and EDS [Epworth Sleepiness Scale (ESS) more than 9] were recruited in a double-blind placebo controlled trial. Twenty-two patients received modafinil 200 mg daily, twenty-six patients received methylphenidate 10 mg daily, and 11 patients received placebo for 6 weeks. Pittsburgh Sleep Quality Index (PSQI) and ESS were
filled out at baseline and 6 weeks later.
Results: There was no significant difference in demographics, PSQI, and ESS variables at baseline. The mean of ESS scores decreased significantly in modafinil (17.36 ± 5.05 vs. 10.55 ± 4.62, P < 0.001) and methylphenidate (16.27 ± 5.40 vs. 12.23 ± 6.28, P < 0.001) groups after 6-week trial, compared with control group (14.27 ± 4.49 vs. 14.09 ± 4.46, P = 0.710). The effectiveness of modafinil and methylphenidate on improving daytime sleepiness and night sleep of patients was not significantly different.
Conclusion: Both modafinil and methylphenidate were effective drugs in improving EDS and quality of sleep without significant difference in efficiency and side effects.
Keywords
- Shen Y, Huang JY, Li J, Liu CF. Excessive daytime sleepiness in parkinson's disease: clinical implications and management. Chin Med J (Engl) 2018; 131(8): 974-81.
- Sateia MJ. International classification of sleep disorders-third edition: Highlights and modifications. Chest 2014; 146(5): 1387-94.
- Hobson DE, Lang AE, Martin WR, Razmy A, Rivest J, Fleming J. Excessive daytime sleepiness and sudden-onset sleep in Parkinson disease: A survey by the Canadian Movement Disorders Group. JAMA 2002; 287(4): 455-63.
- Falup-Pecurariu C, Diaconu S. Sleep dysfunction in Parkinson's disease. Int Rev Neurobiol 2017; 133: 719-42.
- Loddo G, Calandra-Buonaura G, Sambati L, Giannini G, Cecere A, Cortelli P, et al. The treatment of sleep disorders in Parkinson's disease: From research to clinical practice. Front Neurol 2017; 8: 42.
- Sobreira-Neto MA, Pena-Pereira MA, Sobreira EST, Chagas MHN, Fernandes RMF, Tumas V, et al. High frequency of sleep disorders in Parkinson's disease and its relationship with quality of life. Eur Neurol 2017; 78(5-6): 330-7.
- Dauvilliers Y, Roth T, Guinta D, Alvarez-Horine S, Dynin E, Black J. Effect of sodium oxybate, modafinil, and their combination on disrupted nighttime sleep in narcolepsy. Sleep Med 2017; 40: 53-7.
- Nieves AV, Lang AE. Treatment of excessive daytime sleepiness in patients with Parkinson's disease with modafinil. Clin Neuropharmacol 2002; 25(2): 111-4.
- Sheikhina N, Najafi MR, Chitsaz A, Ghadimi K. Evaluation of the effectiveness of methylphenidate and modafinil in the treatment of daily drowsiness in patients with refractory epilepsy and their comparison with the control group. Am J Neurodegener Dis 2021; 10(5): 69-75.
- Thorpy MJ, Schwartz JR, Kovacevic-Ristanovic R, Hayduk R. Initiating treatment with modafinil for control of excessive daytime sleepiness in patients switching from methylphenidate: An open-label safety study assessing three strategies. Psychopharmacology (Berl) 2003; 167(4): 380-5.
- Battleday RM, Brem AK. Modafinil for cognitive neuroenhancement in healthy non-sleep-deprived subjects: A systematic review. Eur Neuropsychopharmacol 2015; 25(11): 1865-81.
- Billiard M, Besset A, Montplaisir J, Laffont F, Goldenberg F, Weill JS, et al. Modafinil: A double-blind multicentric study. Sleep 1994; 17(8 Suppl): S107-S112.
- Banerjee D, Vitiello MV, Grunstein RR. Pharmacotherapy for excessive daytime sleepiness. Sleep Med Rev 2004; 8(5): 339-54.
- Boonstra AM, Kooij JJ, Oosterlaan J, Sergeant JA, Buitelaar JK, Van Someren EJ. Hyperactive night and day? Actigraphy studies in adult ADHD: A baseline comparison and the effect of methylphenidate. Sleep 2007; 30(4): 433-42.
- Challman TD, Lipsky JJ. Methylphenidate: Its pharmacology and uses. Mayo Clin Proc 2000; 75(7): 711-21.
- Devos D, Krystkowiak P, Clement F, Dujardin K, Cottencin O, Waucquier N, et al. Improvement of gait by chronic, high doses of methylphenidate in patients with advanced Parkinson's disease. J Neurol Neurosurg Psychiatry 2007; 78(5): 470-5.
- Leonard BE, McCartan D, White J, King DJ. Methylphenidate: A review of its neuropharmacological, neuropsychological and adverse clinical effects. Hum Psychopharmacol 2004; 19(3): 151-80.
- Mitler MM, Shafor R, Hajdukovich R, Timms RM, Browman CP. Treatment of narcolepsy: Objective studies on methylphenidate, pemoline, and protriptyline. Sleep 1986; 9(1 Pt 2): 260-4.
- Sobanski E, Schredl M, Kettler N, Alm B. Sleep in adults with attention deficit hyperactivity disorder (ADHD) before and during treatment with methylphenidate: A controlled polysomnographic study. Sleep 2008; 31(3): 375-81.
- Black J, Swick T, Bogan R, Lai C, Carter LP. Impact of sodium oxybate, modafinil, and combination treatment on excessive daytime sleepiness in patients who have narcolepsy with or without cataplexy. Sleep Med 2016; 24: 57-62.
- Rodrigues TM, Castro CA, Ferreira JJ. Pharmacological interventions for daytime sleepiness and sleep disorders in Parkinson's disease: Systematic review and meta-analysis. Parkinsonism Relat Disord 2016; 27: 25-34.
- Ando R, Choudhury ME, Yamanishi Y, Kyaw WT, Kubo M, Kannou M, et al. Modafinil alleviates levodopa-induced excessive nighttime sleepiness and restores monoaminergic systems in a nocturnal animal model of Parkinson's disease. J Pharmacol Sci 2018; 136(4): 266-71.
- Bosco A, Lopez R, Barateau L, Chenini S, Pesenti C, Pepin JL, et al. Effect of psychostimulants on blood pressure profile and endothelial function in narcolepsy. Neurology 2018; 90(6): e479-e491.
- Saletu B, Frey R, Krupka M, Anderer P, Grunberger J, Barbanoj MJ. Differential effects of a new central adrenergic agonist--modafinil--and D-amphetamine on sleep and early morning behaviour in young healthy volunteers. Int J Clin Pharmacol Res 1989; 9(3): 183-95.
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