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Modafinil – NOT Recommended for MS Fatigue — SCE Neurology MCQ

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ModerateMultiple Sclerosis & CNS InflammationModafinil – NOT Recommended for MS FatigueSCE Neurology

A 55-year-old man with MS has chronic fatigue that is not adequately managed by non-pharmacological measures or amantadine. He asks about modafinil. What is the NICE position on modafinil for MS fatigue?

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Correct answer: E — Modafinil is NOT recommended by NICE for MS-related fatigue due to insufficient evidence of efficacy in this population — it should not be routinely prescribed

NICE NG100 does not recommend modafinil for MS-related fatigue. While it is licensed for narcolepsy and used off-label for various causes of excessive sleepiness, the evidence for its efficacy in MS fatigue specifically is insufficient. The NICE evidence review concluded that the benefits were unclear and did not justify routine prescription. Non-pharmacological approaches (exercise, CBT for fatigue, energy conservation) remain the evidence base, with amantadine as a modest pharmacological option. A: Not recommended by NICE for MS fatigue. C: No medication cures MS fatigue. D: Not formally contraindicated, just not recommended. E: Modafinil has broader uses but not NICE-recommended for MS fatigue.

Reference: NICE NG100 MS (2022)