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Treatment of Post Stroke Fatigue using Provigil

Fatigue is a common yet relatively under covered consequence of stroke that can cause potentially negative effects on the quality of life of an individual. There have been several pharmacologic and non-pharmacologic interventions that have been proposed and investigated in this regard.

Provigil is often prescribed to treat excessive sleepiness caused by apnea, depression, narcolepsy and sleep disorders.  This condition can be extremely dangerous and life-threatening, since it happens so unexpectedly and can suddenly kick in when the person is driving or operating heavy machinery.

Research Study involving the effectiveness of Provigil on treating post stroke fatigue

A study conducted by Poulsen involved subjecting patients through a phase three, placebo controlled clinical trial by administering appropriate dosages of Provigil. The end result was the reduction of fatigue within 90 days with several additional measures such as improvement in the overall quality of life, cognition, mood, neurologic outcome, bone density, and muscle mass at 30, 90 and 180 days respectively. In order to isolate cases of post stroke fatigue from other medical conditions, the researchers basically selected 41 subjects at random from a pool of 1121. These patients also suffered from a stroke 14 days earlier to the study. The subjects were treated with Provigil (a prescribed dosage of 400mg) in a single daily dose administered in the mornings for 90 days.No serious side-effects were reported for Provigil during the study.

What conclusions were drawn based on the experiment?

The primary end point parameters were assessed by the Multidimensional Fatigue Inventory. The secondary end results were studied on the Fatigue Severity Scale, Montreal Cognitive Assessment, and the modified Rankine scales.

The primary results did not differ for patients receiving treatment from either Provigil or placebo. However, the Fatigue Severity Scale carried out after the administration period, noted significant reduction in fatigue levels of those subjected to Provigil. A lot of improvement was also seen in various domains such as language, work and productivity at 30 and 90 days.

Given these observations, we can safely conclude that Provigil may be effective in curbing post stroke fatigue to a certain degree amongst carefully selected subjects.

What triggers stroke in patients and what treatment methods are followed to tackle this problem?

Some of the reasons why stroke occurs,

  1. Physical Changes
  2. Fatigue and Depression
  3. Cognitive Impairment
  4. Habits and Lifestyle

These factors lead to structural alterations of the brain, also causing a major depletion in neurochemicals such as norepinephrine and serotonin. This in turn leads to occurrence of stroke in the individual. When the disorder is diagnosed early it may be quite possible to treat the patient fully. There are a few steps that may be followed,

  1. We must identify if the condition requires pharmacological (Provigil) or physiological treatment.
  2. A platform to educate the patient as well as their families to cope with fatigue caused due to strokes.

Provigil is probably the go-to treatment to overcome post stroke fatigues, but in the long term medication combined with physiological intervention may prove to be useful and aid recovery.

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