Modafinil for treatment of coma and unresponsiveness associated with edema of the reticular activating system (RAS) in a pediatric patient

Degaetano M,Fellus J,Sernas Tj,Mazzola Ca

doi:10.15761/pmrr.1000169

Abstract

Modafinil for treatment of coma and unresponsiveness associated with edema of the reticular activating system (RAS) in a pediatric patient

Highlights

Modafinil is recommended as a possible treatment for Attention Deficit Hyperactivity Disorder (ADHD), narcolepsy, obstructive sleep apnea, and shift work disorder in adults but is not recommended by the Food and Drug Administration (FDA) or manufacturer for use on pediatric patients due to some of the observed side effects in clinical studies [6]
We report an unusual case of a child with post-operative coma and reticular activating system (RAS) edema who responded well to Modafinil
Multiple level one studies have tested the efficacy and safety of modafinil on children with ADHD [6,7,8,9,10,11,12]. Each of these studies recommended that modafinil could serve as a welltolerated and effective treatment route for pediatric patients affected by ADHD

Summary

Introduction

Modafinil is recommended as a possible treatment for ADHD, narcolepsy, obstructive sleep apnea, and shift work disorder in adults but is not recommended by the FDA or manufacturer for use on pediatric patients due to some of the observed side effects in clinical studies [6]. A follow-up MRI showed that there was approximately 2-3% of residual tumor and extensive edema along the upper brainstem around the reticular activating system (RAS). 10 days later, the modafinil was restarted to aid in the wakefulness of the patient. The modafinil was gradually increased from 25 mg once daily to 75 mg once daily whereas the caffeine remained at 200 mg once daily These medications were discontinued upon being discharged from the hospital a week later and were not restarted because the patient was very awake and alert. While the patient improved to the point where he could open his eyes spontaneously and follow commands, he still had significant hypotonia and dysphasia The patient did develop some mild skin rashes, most likely as a side effect of the modafinil

Discussion

Conclusion