Wonder what "break through" cognitive symptoms means? I've never heard that phrase before.

Combination of Modafinil and Interferon-Beta-1a Appears Effective and Safe for Treatment of Cognitive Symptoms in Multiple Sclerosis: Presented at ECTRIMS

http://www.docguide.com/news/content...2571FA00685E48

And from the Ectrims site:

http://registration.akm.ch/einsicht....NMASKEN_ID=900

Final analysis of combination therapy (Provigil® + Avonex®) in the treatment of cognitive problems in patients with relapsing-remitting multiple sclerosis

J.A. Wilken, M.T. Wallin, C.L. Sullivan, R.L. Kane, H. Rossman, S. Lawson, J. Simsarian, C. Saunders, R. Shin, J. Mikszewski, D. Kerr, M.E. Quig (Washington, Baltimore, Farmington Hills, Fairfax, Arlington, USA)

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There is evidence that treatment of multiple sclerosis (MS) with interferons can slow the progression of cognitive dysfunction associated with the disease. Scant data exist, however, regarding the treatment of breakthrough cognitive symptoms (e.g., attention, processing speed, and memory problems). Although studies have recently demonstrated the benefits of using modafinil as an adjunctive therapy to treat fatigue caused by MS, there are no data on whether this treatment translates into improved functioning in patients with cognitive impairment that progresses even while on a disease-modifying agent.

The objective of this study was to determine whether combination therapy (modafinil plus interferon beta-1a, Avonex) was safe and effective in treating the progression of cognitive deficits in MS. Preliminary data from this study was presented at prior scientific conferences (AAN, CMSC).

The current pilot study had a multi-center, randomized, parallel-group design and was intended to assess safety and provide preliminary data regarding efficacy of adjunctive treatment with modafinil. MS patients already taking interferon beta-1a (Avonex) completed an attention screening battery. Those patients who demonstrated significant attention problems were randomized to receive modafinil (200 mg/day) or no additional treatment. Evaluators were blinded to medication status.

Subjects underwent a complete neuropsychological battery (including measures of mood and QOL) at baseline and four months. Side effects were closely monitored to determine the relative safety of this combination therapy. 59 patients were enrolled: 29 in the combination group and 30 in the IFN-beta-1a alone group. 48 patients completed the 4-month evaluation. At baseline, mean age was 47.11 +/-10.03 years, mean years of education were 14.85+/- 2.19, mean EDSS score was 3.95+/-2.06, and mean estimated Full Scale IQ was 107.72 +/-7.49. There were no significant differences in demographic variables between groups.

Side effects of combination therapy were mild and no different from those described in the package inserts for both medications. Compared with the IFN-beta-1a alone group, patients in the combination therapy group demonstrated significant improvement from baseline on neurocognitive, fatigue, mood, and QOL measures at 4 months. In this pilot study, the use of modafinil in addition to interferon-beta-1a (Avonex) for breakthrough cognitive symptoms appeared to be safe and effective.