Fatigue is a common complaint among people with multiple sclerosis (MS). It occurs in about 80% of patients and is a primary reason why patients leave the workforce via early retirement. Fatigue management plans are normally advised to help patients make behavioral changes and develop strategies that could improve the condition.

Provigil (modafinil) is used to promote wakefulness in adults with sleep disorders that include narcolepsy, obstructive sleep apnea, or shift work disorder. It is used off-label by people with MS to treat fatigue and sleepiness.

In 2010, however, the European Medicines Agency’s Committee for Medicinal Products for Human Use (CHMP) recommended that drug’s use should be restricted only to narcolepsy because it is only in narcolepsy that the benefit of modafinil outweighs the risk. CHMP called for all other indications to be withdrawn from modafinil use.

Serious side effects of Provigil (modafinil) can include severe rash or allergic reaction, depression, feeling anxious, hearing things, hallucinations, manic state, thoughts of suicide, aggressive behavior, and heart problems such as chest pain or abnormal heartbeat. Common side effects include headache, dizziness, anxiety and feeling nervous, back pain, nausea, diarrhea and upset stomach, insomnia, and stuffy nose.

Modafinil is a tablet taken by mouth and in doses strictly prescribed by a medical doctor.

Provigil is a federally controlled substance because it can be abused or lead to drug dependency. It must be kept in a safe place to prevent misuse and abuse. Selling or giving away provigil may cause harm to others and is against the law.

The drug works by selective activation in the brain’s hypothalamus, which controls normal sleep and wakefulness patterns.  Unlike other central nervous system stimulants, modafinil does not cause excessive tiredness (crash) as it wears off.

There are generic products for modafinil but they are not available due to certain patent or exclusivity issues.


Note: Multiple Sclerosis News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.

National MS Society Awards $12M to 40 Research Projects in US and Elsewhere

The National Multiple Sclerosis Society (NMSS) has pledged $12 million to support 40 new, multi-year research projects focused on “stopping MS, restoring lost function, and ending the disease forever,” the organization announced in a press release. This commitment — the last allocation set aside for research in 2018 —  brings to $35.8 million society support for research […]

Lower Fatigue Reported by MS Patients after aHSCT in Canadian Study

A small group of multiple sclerosis (MS) patients with aggressive disease, who were treated with hematopoietic stem cell transplant in a clinical trial, reported a drop in their fatigue levels that researchers suggested was likely due to lesser inflammation. The study, “Autologous hematopoietic stem cell transplantation improves fatigue in multiple sclerosis,”  was published in the Multiple […]

Truly ‘Benign MS’ Evident in Only Small Minority of Patients, Large UK Study Reports

Multiple sclerosis (MS) that appears to be “genuinely benign” 15 years after diagnosis is evident in a small number of patients, a large population-based study from the U.K. reports.

But, its researchers note, the term “benign” is often not clinically accurate as used, because it is based largely on perceptions of disease impact.

The study “How common is truly benign MS in a UK population?” was published in the Journal of Neurology, Neurosurgery & Psychiatry.

The concept of benign MS is controversial, especially among clinicians. Still, long-term epidemiological studies have consistently identified a small fraction of patients whose MS progresses very slowly over a long span of years.

Determining the prevalence of this type of MS in the population has been difficult, as estimates can vary significantly depending of the definition of “benign” that is adopted.

Researchers sought to determine an accurate estimate of benign MS in the U.K. population, using a rigorous and comprehensive clinical definition of a truly benign disease.

This definition included minimal physical disability (EDSS score of less than 3), and no significant fatigue, mood disturbance, cognitive impairment or interrupted employment in the absence of treatment with disease-modifying therapies over 15 years or more years after symptom onset.

They screened an U.K. population-based registry containing data on 3,062 MS patients to identify those with “unlimited walking ability” 15 or more years after diagnosis.

A representative sample of 60 patients  from this pool was analyzed (45 women and 15 men, mean age of 57); they had a mean disease duration of 28 years.

Nine out of these 60 (15%; 8 women and one men) fulfilled the study’s criteria for truly benign disease. These nine people had a mean age of 27 at symptom onset, a median EDSS disability score of 1.5 (minimal signs of disability), and a mean disease duration of 31 years.

“Those nine individuals with truly benign MS all remained in a relapsing–remitting state,” the study noted. “However, only two out of nine showed disease arrest within the first decade; the remainder all continued to experience relapses well into their second or third decade of MS,” but the rates of such relapses were low.

MS in the remaining patients was not classified as benign, mostly due to evidence of cognitive difficulties (57%), and the disease’s impact on employment status (52%) with many taking early retirement.

Based on these results, a population frequency for “benign MS” under the definitions used was estimated at 2.9%.

But the researchers noted that a large proportion of patients (65%; 39 patients out of 60) reported their disease as benign, according to a lay definition. Their self-reported status poorly agreed with the clinical assessments done throughout the study.

“There is no accepted definition to offer patients when exploring whether they feel their MS is benign; the definition we chose incorporates the fundamental principles of low impact on a person, absence of complications and a favourable outcome and is in line with definitions provided by third-party support groups,” the researchers wrote.

Many  considering themselves with benign disease did so based on their “perception” of their disease, the team added, and one that “appeared to be driven as much by mood, fatigue and bladder function as by physical ability.” 

“In conclusion, after detailed clinical assessment, a small minority of people with MS appear genuinely unaffected by symptoms after 15 years,” the researchers added.

They also called attention to the fact that EDSS-based definitions of benign MS and the inconsistency between patient and clinician perception of benign MS compromise the use of the term ‘benign’ in clinical practice.

They also emphasize that studying individuals with benign MS “has the potential to uncover clues to mechanisms underlying favorable outcomes in MS, provide insights into new therapeutic targets and have implications for patient counselling, individual patient management and the construct of clinical trials.”

Smoking Aggravates Respiratory Complications, Increases Sedentary Lifestyle in MS Patients, Study Reports

Cigarette smoking worsens shortness of breath and fatigue, increases the rate of hospital admissions, and fosters a sedentary lifestyle in patients with multiple sclerosis (MS), according to a new study. The research, “Effects of cigarette smoking on respiratory problems and functional levels in multiple sclerosis patients,” was published in the journal Multiple Sclerosis and Related […]

Poor Sleep Common in MS, Linked to Fatigue, Depression, and Anxiety, Study Reports

Poor sleep quality is very common among patients with relapsing-remitting multiple sclerosis (RRMS) or clinically isolated syndrome (CIS), and is associated with a lower quality of life, and greater fatigue, depression and anxiety, according to a real-world study in patients treated with Betaferon (interferon beta-1b). The study, “Sleep quality, daytime sleepiness, fatigue, and quality of […]

Exercise Fights Fatigue and Depression in MS Patients, Study Reveals

Physical exercise fights fatigue and depression in patients with multiple sclerosis (MS), a new study reveals. Remarkably, these positive outcomes in psychological health can be achieved without significant alterations in the patient’s body weight or body mass index (BMI), further supporting the idea that exercise could be an effective therapeutic intervention for MS. The study with […]

I’m Busy Doing Nothing

Everything takes so much damn time! I’m strangely working — or at least doing things I purport as work, such as this column. That’s no different than before MS; I still have the inclination to prevaricate or find something inconsequential to ruminate over, like the state of the Turkish economy or that game of patience […]

Downbeat, but Upbeat

Most weeks with MS are downbeat. That’s hardly a way to capture a reader’s attention — all of us struggle. What we need is light to blow away the shade. Last night as I climbed the stairs to bed, my legs gave out with three stairs to go. Luckily, I had two strapping sons on […]

Down for the Weekend: World Cup Fatigue

Hi, everyone. I’m absolutely exhausted. And it’s all the fault of the World Cup. Not from any sort of secondary exercise while watching games, but because it’s given me the week off work. England lost their last group match to Belgium on June 29. Their last 16 game — against Colombia — was set to […]