Modafinil for the treatment of diminished responsiveness in a patient recovering from brain surgery

Abstract

Primary objective: This case report reviews the history and post-operative status of a 77-year-old woman who underwent transcallosal resection of an intra-ventricular haemorrhagic subependymoma and who remained in a deep post-operative state of lethargy and listlessness.

Main outcome measures: Glasgow Coma Scale (GCS) and detailed clinical observations.

Results: The patient (GCS = 8) was initiated on methylphenidate 20 mg per day on the 6th day after surgery, but treatment was discontinued 2 days later due to elevated blood pressure and persistent tachycardia. Pemoline 37.5 mg per day was initiated, but treatment was stopped after 3 days due to lack of response. Treatment with modafinil 400 mg per day was initiated on the 11th day after surgery and the patient's consciousness level rapidly improved on the 14th day. On the 16th day after surgery, she was completely alert (GCS = 15).

Conclusions: Modafinil appeared to be beneficial for improving wakefulness and responsiveness in a patient with central nervous system trauma in the post-operative state.

• Modafinil
• Glasgow coma scale
• level of consciousness
• brain surgery