Fatigue is among the most common and debilitating symptoms of MS, with up to 90% of those with MS reporting the symptom. While behavioral and pharmacological interventions exist, how they work together is yet to be evaluated for MS-related fatigue.
In the current research, researchers sought to compare the effectiveness of cognitive behavioral therapy (CBT), modafinil, and their combination for treating MS-related fatigue. Modafinil is a stimulant medication used to treat sleep disorders such as narcolepsy.
For the study, researchers recruited 336 adults with MS and problematic fatigue. They were randomly assigned to receive CBT, modafinil, or combination therapy for 12 weeks. Ultimately, they found that all of the treatment variations produced similar reductions in fatigue, and that combination therapy was not linked to more significant improvements compared to individual interventions.
They noted, however, that drug efficacy appeared to be affected by participants' sleep habits or 'sleep hygiene.' They found, for example, that those with poor sleep hygiene tended to have better outcomes with CBT, whereas those with pre-existing good sleep hygiene tended to have better outcomes with modafinil. Altogether, over 60% of participants in each group reported clinical improvements in symptoms of fatigue, and no serious adverse events were reported for the study drug.
"Using wake-promoting medications such as modafinil could worsen sleep quality in patients whose sleep problems are behavioral in nature," said the first author of the study, Tiffany J. Braley, M.D., M.S., director of the Multiple Sclerosis/Neuroimmunology Division and co-founder of the Multidisciplinary MS Fatigue and Sleep Clinic at the University of Michigan Health, in a press release.
"As sleep disturbances also contribute to fatigue in people with MS, it is important to avoid selecting fatigue treatments that could make sleep worse. Behavioral treatments such as CBT that include sleep education may be preferable for people with MS who have poor sleep habits," added Braley.
The findings suggest that all of the treatments studied- whether individually or in combination- may be considered potential treatment options for MS. The researchers noted, however, that further research is required to determine whether the effects of these interventions on MS-related fatigue are influenced by sleep hygiene and sleepiness.
Sources: Science Daily, The Lancet Neurology