Abstracts

Rationale: Modafanil is a medication used to improve wakefulness in patients with hypersomnolence due to narcolepsy, obstructive sleep apnea (OSA) or shift-work disorder. Patients on anti-epileptic drugs (AEDs) often have sleepiness as an adverse reaction. Many patients cannot have their AEDs adjusted or changed due to seizures that have been difficult to control. Methods: The records of 14 epilepsy patients (9 female, 5 male) from 12-17 years old (mean: 14.3 years) were retrospectively reviewed. All had either primary-generalized or localization-related epilepsy refractory to multiple AEDs but stable in seizure frequency on their current regimen. Only one patient had a polysomnogram (PSG) done for presumed OSA 1 year prior to starting modafinil. The study was negative. The patients were on 1-3 AEDs (mean: 2 AEDs). All had patient- and/or parent-reported somnolence on their AEDs. Modafinil was started at 100mg every morning. The dose was adjusted based on improvement in wakefulness. Patients were followed on modafinil for 4-11 months (mean: 8 months). Results: Final modafinil doses ranged from 100mg-400mg per day with a mean dose of 200mg daily. All patients had patient- and/or parent-reported improvement in somnolence. Only one had a worsening in seizure frequency. Modafinil was stopped in this patient without improvement in seizure frequency. No other adverse reactions were reported. Three patients discontinued modafinil due to cost. Conclusions: Modafinil can improve AED-induced sleepiness in pediatric patients who cannot safely have there AEDs changed or adjusted. Modafinil does not appear to increase seizure frequency in these patients. A prospective study including a PSG and multiple sleep latency test to rule out other causes of hypersomnolence is needed.