Walking With Modafinil and Its Use in Diplegic Cerebral Palsy: Retrospective Review

Daniel L. Hurst MD; Walter A. Lajara-Nanson MD; Margie E. Lance-Fish RN

Disclosures

J Child Neurol. 2006;21(4):294-297. 

In This Article

Abstract and Introduction

A retrospective review of pediatric patients with spastic cerebral palsy was undertaken at Texas Tech University Health Sciences Center covering a period from January 1, 2000, until December 31, 2003. One hundred twenty pediatric patients were identified in the Texas Tech University Health Sciences Center child neurology clinic with spastic cerebral palsy. Fifty-nine patients of this group received modafinil treatment for cerebral palsy. Twenty-nine of the 59 patients were noted to have an improving gait on modafinil. Six of these modafinil-treated patients improved from no ambulation or only assisted ambulation to unassisted ambulation. This varied from taking a few steps without holding on to walking down the hall without assistance. Two patients with spastic diplegia secondary to prematurity have had a dramatic improvement in gait during the first 6 months after starting modafinil. Two other patients with spastic diplegia not included in this group of six patients taught themselves to stand up and walk while in water unassisted. During this same time period, only three non-modafinil-treated patients with mild cerebral palsy were noted with gait improvements, but not to the dramatic extent of the modafinil-treated group. A nonambulatory 5-year-old child, who presented for a requested wheelchair prescription because the mother had given up all hope of her child ever walking, is now taking independent steps unassisted after starting modafinil. Modafinil, a central nervous system stimulant, appears to improve tone and ambulation in spastic diplegic cerebral palsy.

The first use of modafinil for spastic cerebral palsy was at Texas Tech University Health Sciences Center in early 2000.[1] A pilot study in late 2000 showed beneficial effects documenting a reduction in spasticity with modafinil treatment.[1] A second study, a retrospective review undertaken in late 2001, reviewed 30 patients with cerebral palsy treated with modafinil, again showing an apparent benefit to treatment.[2] Families and patients continue to come from a variety of sources, referred specifically for modafinil treatment or requesting modafinil treatment for spastic cerebral palsy. Because of further favorable observations in modafinil-treated patients at Texas Tech University Health Sciences Center, as noted in our two case studies, we undertook another retrospective review of pediatric patients with cerebral palsy at Texas Tech University Health Sciences Center to identify and compare those patients who have started walking while on modafinil with those patients with cerebral palsy who have not yet begun walking. This new study of modafinil looks at gait as an assessment of long-term functioning in cerebral palsy.

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