Amantadine versus methylphenidate in multiple sclerosis for fatigue

Multiple sclerosis (MS) is a common neurological disorder with a variety of manifestations including fatigue. Fatigue is the most common symptom of MS and may interfere with daily work and activities. Amantadine and amphetamine-like stimulants are commonly used in clinical practice for treatment of fatigue; however, the evidence supporting their effectiveness is sparse and conflicting. In this study, the effect of methylphenidate (Ritalin) and amantadine in the treatment of fatigue was compared.METHODS: In this randomized clinical trial, 60 MS patients with fatigability were enrolled (mean age ± standard deviation: 37 ± 9, Female/male ratio: 4/1). Patients were assigned to a one month treatment with either amantadine 200mg, Ritalin 20mg or placebo. Efficacy of the treatment was evaluated by using the modified fatigue impact scale (MFIS).RESULTS: Contrast analysis showed significantly lower mean MFIS score after one month in patients on amantadine compared to placebo (mean difference=16.7, p=0.001). There was also a trend of a lower MFIS score in Ritalin group in comparison to placebo (mean difference=13.1, p=0.05).There was no statistically significant difference between two regimens in terms of the MFIS score before and after treatment and the frequency of complications.CONCLUSION: Both amantadine and Ritalin reduce fatigue in MS patients, and both have equal effects.