Cleveland Clinic journal of medicine
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Modafinil (Provigil) is approved for treating excessive daytime sleepiness associated with narcolepsy, for shift-work sleep disorder, and as an adjunctive treatment in patients with obstructive sleep apnea syndrome who have residual daytime sleepiness despite optimal treatment with continuous positive airway pressure. Although modafinil improves measures of sleepiness, it does not generally normalize them, and it may be less effective than other stimulants for some narcoleptic patients. We need head-to-head comparisons of modafinil with traditional stimulants in humans to better define its role. We review the current approved and off-label uses of this drug and the evidence behind them.
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The Spine Patient Outcomes Research Trial (SPORT) consisted of two parallel studies: an observational study and a randomized comparison of medical and surgical treatment of disk herniation. In the long-term, patients did well with either treatment, and an intention-to-treat analysis found no difference in outcomes. However, at 2 years 40% of patients in the surgical group of the randomized study still hadn't had surgery, and 40% of the medical patients did have surgery, muddying the results. Surgery was superior according to an analysis by the treatment patients actually received, but the study has been criticized for methodologic shortcomings, and the topic remains controversial.