Abstracts

Rationale: Adolescent epilepsy patients on multiple anti-epileptic drugs (AEDs) often complain of excessive daytime sleepiness (EDS). Many of these patient cannot have their AEDs adjusted because of the risk of increased seizures. Armodadanil, an isomer of modafinil that is approved for EDS associated with shift-work disorder and narcolepsy, may improve sleepiness in these epilepsy patients. Our practice often uses modafinil and armodafanil for excessive sleepiness in patients with difficult to control seizures on multiple AEDs.Methods: A retrospective chart review was performed. Patients met inclusion criteria if they had EDS reported by the patient or care giver and were treated with armodafinil for at least 3 months. Patients had to have a stable seizure frequency for at least 3 months prior to starting armodafinil. Ages could range from 12-18 years old. Patient had to be on more than 1 AED.Results: Twelve patients met criteria to be included in the study. Ages ranged from 12-17 years (mean: 14.6 years). Seven (58%) were male and 5 (42%), female. All patients had localization-related epilepsy. Ten patients (83%) were on 2 AEDs and 2 patients (17%) were on 3 AEDs. Patients were all started on 150mg of armodafinil in the morning. Eight patients (67%) had the dose increased to 250mg daily. Treatment time ranged from 4-12 months (mean: 7.6 months). Eleven patients or their care givers (92%) reported improvement in EDS. The one patient who did not have improvement in EDS was also the only patient to come off armodafinil. One patient had irritability on armodafanil but continued to take it. No other side effects were reported. None of the patients had an change in their reported seizure frequency on armodafinil.Conclusions: Armodafanil appears to improve excessive daytime sleepiness in adolescent epilepsy patients on more than one AED. It does not appear to increase seizure frequency in these patients. A prospective study including detailed sleep investigations and standardized sleepiness scales in needed.