A randomized trial on the efficacy of methylphenidate and modafinil for improving cognitive functioning and symptoms in patients with a primary brain tumor
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Limited research is available regarding the efficacy of psychostimulants in treating cognitive function in primary brain tumor patients. An open-label, randomized, pilot trial examined both the general and differential efficacy of 4 weeks of methylphenidate (MPH) and modafinil (MOD) in 24 brain tumor patients. Participants completed cognitive tests and self-report measures of fatigue, sleep disturbance, mood and quality of life at baseline and after 4 weeks.
Following stimulant treatment, there was evidence of a beneficial effect on test performance in speed of processing and executive function requiring divided attention. Patients with the greatest deficit in executive function at baseline appeared to derive the greatest benefit following stimulant therapy. Inconsistent, differential effects were found on a measure of attention in favor of MPH and on a measure of processing speed in favor of MOD. There was also evidence of a general beneficial effect on patient-reported measures of fatigue, mood, and quality of life, with no statistically significant differences between treatment arms in these measures over time. The results from this small pilot study should be interpreted with caution, but appear to warrant additional research, in larger study samples, targeting fatigue, processing speed and executive function, and exploring different doses of stimulants. Future studies may also wish to explore the specific patient factors that may be associated with responsiveness to psychostimulant treatment.
KeywordsCognitive deficit Brain tumor Psychostimulant Stimulant treatment
- 4.Hannestad J, Gallezot JD, Planeta-Wilson B, Lin SF, Williams WA, van Dyck CH, Malison RT, Carson RE, Ding YS (2010) Clinically relevant doses of methylphenidate significantly occupy norepinephrine transporters in humans in vivo. Biol Psych 68:854–860. doi: 10.1016/j.biopsych.2010.06.017 CrossRefGoogle Scholar
- 9.Volkow ND, Fowler JS, Logan J, Alexoff D, Zhu W, Telang F, Wang GJ, Jayne M, Hooker JM, Wong C, Hubbard B, Carter P, Warner D, King P, Shea C, Xu Y, Muench L, Apelskog-Torres K (2009) Effects of modafinil on dopamine and dopamine transporters in the male human brain: clinical implications. JAMA 301:1148–1154. doi: 10.1001/jama.2009.351 PubMedCrossRefGoogle Scholar
- 17.Weitzner MA, Meyers CA, Valentine AD (1995) Methylphenidate in the treatment of neurobehavioral slowing associated with cancer and cancer treatment. J Neuropsyc Clin Neurosci 7:347–350Google Scholar
- 19.Kaleita TA, Wellisch DK, Graham CA, Steh B, Nghiemphu P, Ford JM, Lai A, Peak S, Cloughesy TF (2006) Pilot study of modafinil for treatment of neurobehavioral dysfunction and fatigue in adult patients with brain tumors. J Clin Oncol 24:1503Google Scholar
- 20.Butler JM Jr, Case LD, Atkins J, Frizzell B, Sanders G, Griffin P, Lesser G, McMullen K, McQuellon R, Naughton M, Rapp S, Stieber V, Shaw EG (2007) A phase III, double-blind, placebo-controlled prospective randomized clinical trial of d-threo-methylphenidate HCl in brain tumor patients receiving radiation therapy. Int J Radiat Oncol Biol Phys 69:1496–1501PubMedCrossRefGoogle Scholar
- 27.Mar Fan HG, Clemons M, Xu W, Chemerynsky I, Breunis H, Braganza S, Tannock IF (2008) A randomised, placebo-controlled, double-blind trial of the effects of d-methylphenidate on fatigue and cognitive dysfunction in women undergoing adjuvant chemotherapy for breast cancer. Support Care Cancer 16:577–583. doi: 10.1007/s00520-007-0341-9 PubMedCrossRefGoogle Scholar
- 32.Wechsler D (1997) Wechsler adult intelligence scale III. Psychological Corporation, San AntonioGoogle Scholar