- Title
- Predicting modafinil-treatment response in poststroke fatigue using brain morphometry and functional connectivity
- Creator
- Visser, Milanka M.; Maréchal, Bénédicte; Goodin, Peter; Lillicrap, Thomas P.; Garcia-Esperon, Carlos; Spratt, Neil J.; Parsons, Mark W.; Levi, Christopher R.; Bivard, Andrew
- Relation
- Stroke Vol. 50, Issue 3, p. 602-609
- Publisher Link
- http://dx.doi.org/10.1161/STROKEAHA.118.023813
- Publisher
- Lippincott Williams & Wilkins
- Resource Type
- journal article
- Date
- 2019
- Description
- Background and Purpose: Poststroke fatigue affects a large proportion of stroke survivors and is associated with a poor quality of life. In a recent trial, modafinil was shown to be an effective agent in reducing poststroke fatigue; however, not all patients reported a significant decrease in fatigue with therapy. We sought to investigate clinical and radiological predictors of fatigue reduction with modafinil therapy in a stroke survivor cohort. Methods: Twenty-six participants with severe fatigue (multidimensional fatigue inventory–20 ≥60) underwent magnetic resonance imaging at baseline and during the last week of a 6-week treatment period of 200 mg modafinil taken daily. Resting-state functional magnetic resonance imaging and high-resolution structural imaging data were obtained, and functional connectivity and regional brain volumes within the fronto-striato-thalamic network were obtained. Linear regression analysis was used to identify predictors of modafinil-induced fatigue reduction. Results: Multiple regression analysis showed that baseline multidimensional fatigue inventory–20 score (β=0.576, P=0.006) and functional connectivity between the dorsolateral prefrontal cortex and the caudate nucleus (β=−0.424, P=0.008) were significant predictors of modafinil-associated decreases in poststroke fatigue (adjusted r²=0.52, area under the receiver operator characteristic curve=0.939). Conclusions: Fronto-striato-thalamic functional connectivity predicted modafinil response for poststroke fatigue. Fatigue in other neurological disease has been attributed to altered function of the fronto-striato-thalamic network and may indicate that poststroke fatigue has a similar mechanism to other neurological injury related fatigue. Self-reported fatigue in patients with normal fronto-striato-thalamic functional connectivity may have a different mechanism and require alternate therapeutic approaches. Clinical Trial Registration: URL: https://www.clinicaltrials.gov. Unique identifier: ACTRN12615000350527
- Subject
- caudate nucleus; fatigue; modafinil; magnetic resonance imaging; quality of life; SDG 3; Sustainble Development Goals
- Identifier
- http://hdl.handle.net/1959.13/1407407
- Identifier
- uon:35721
- Identifier
- ISSN:0039-2499
- Rights
- This is a non-final version of an article published in final form in Stroke available from https://doi.org/10.1161/STROKEAHA.118.023813.
- Language
- eng
- Full Text
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Goal 3: Good Health and Well-Being
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