Saletu Michael, Anderer Peter, Semlitsch Heribert V, Saletu-Zyhlarz Gerda Maria, Mandl Magdalena, Zeitlhofer Josef, Saletu Bernd
Department of Neurology, Medical University of Vienna, Vienna, Austria.
Psychiatry Res. 2007 Jan 15;154(1):69-84. doi: 10.1016/j.pscychresns.2006.04.005. Epub 2006 Dec 20.
Low-resolution brain electromagnetic tomography (LORETA) showed a functional deterioration of the fronto-temporo-parietal network of the right hemispheric vigilance system in narcolepsy and a therapeutic effect of modafinil. The aim of this study was to determine the effects of modafinil on cognitive and thymopsychic variables in patients with narcolepsy and investigate whether neurophysiological vigilance changes correlate with cognitive and subjective vigilance alterations at the behavioral level. In a double-blind, placebo-controlled crossover design, EEG-LORETA and psychometric data were obtained during midmorning hours in 15 narcoleptics before and after 3 weeks of placebo or 400 mg modafinil. Cognitive investigations included the Pauli Test and complex reaction time. Thymopsychic/psychophysiological evaluation comprised drive, mood, affectivity, wakefulness, depression, anxiety, the Symptom Checklist 90 and critical flicker frequency. The Multiple Sleep Latency Test (MSLT) and the Epworth Sleepiness Scale (ESS) were performed too. Cognitive performance (Pauli Test) was significantly better after modafinil than after placebo. Concerning reaction time and thymopsychic variables, no significant differences were observed. Correlation analyses revealed that a decrease in prefrontal delta, theta and alpha-1 power correlated with an improvement in cognitive performance. Moreover, drowsiness was positively correlated with theta power in parietal and medial prefrontal regions and beta-1 and beta-2 power in occipital regions. A less significant correlation was observed between midmorning EEG LORETA and the MSLT; between EEG LORETA and the ESS, the correlation was even weaker. In conclusion, modafinil did not influence thymopsychic variables in narcolepsy, but it significantly improved cognitive performance, which may be related to medial prefrontal activity processes identified by LORETA.
低分辨率脑电磁断层扫描（LORETA）显示发作性睡病患者右半球警觉系统的额颞顶网络功能退化以及莫达非尼的治疗效果。本研究的目的是确定莫达非尼对发作性睡病患者认知和精神心理变量的影响，并调查神经生理警觉性变化是否与行为水平上的认知和主观警觉性改变相关。在一项双盲、安慰剂对照的交叉设计中，在上午中段时间获取了15名发作性睡病患者在服用安慰剂3周和服用400毫克莫达非尼前后的脑电图-LORETA和心理测量数据。认知调查包括保利测试和复杂反应时间。精神心理/心理生理评估包括驱力、情绪、情感、清醒度、抑郁、焦虑、症状自评量表90和临界闪烁频率。还进行了多次睡眠潜伏期测试（MSLT）和爱泼华嗜睡量表（ESS）。服用莫达非尼后的认知表现（保利测试）明显优于服用安慰剂后。关于反应时间和精神心理变量，未观察到显著差异。相关分析显示，前额叶δ波、θ波和α1波功率的降低与认知表现的改善相关。此外，嗜睡与顶叶和内侧前额叶区域的θ波功率以及枕叶区域的β1波和β2波功率呈正相关。上午中段脑电图-LORETA与MSLT之间的相关性不太显著；脑电图-LORETA与ESS之间的相关性更弱。总之，莫达非尼对发作性睡病患者的精神心理变量没有影响，但它显著改善了认知表现，这可能与LORETA识别出的内侧前额叶活动过程有关。
