Myotonic dystrophy is an inherited muscular dystrophy causing muscle weakness and wasting. Many people with myotonic dystrophy complain about excessive daytime sleepiness. This symptom is related to disordered central respiratory control. Psychostimulants are drugs that increase alertness and include caffeine, amphetamine, selegiline, methylphenidate and modafinil. In this updated review there were few randomized controlled trials which evaluated the efficacy and safety of psychostimulants in myotonic dystrophy. One randomized controlled trial of selegiline involving 11 participants did not demonstrate any benefit. Four studies of another drug modafinil suggested inconsistent and slight benefits. Only two of these studies used the gold standard test, a sleepiness scale, to evaluate hypersomnia and found non significant improvement. In these four studies modafinil seemed well tolerated. Further randomized trials are needed to determine the utility of psychostimulants for myotonic dystrophy.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

A primary brain tumour (PBT) is a cancer that began in the brain rather than spread from other parts of the body. Fatigue (tiredness) is common in people with a PBT. This may be due to the tumour, its treatment or to the use of other medicines such as antiepileptic drugs (which are used to treat epilepsy seizures). It may also occur with other symptoms such as sleep disturbance, thinking problems and emotional distress. Treatments to help manage fatigue may improve a person's quality of life, their ability to tolerate cancer treatment (which themselves are associated with fatigue), and their ability to carry out social and day‐to‐day activities.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Amphetamine dependence constitutes a public health problem with many consequences and complications. Amphetamine abuse refers to a maladaptive and hazardous pattern of use considered to be less severe than dependence. To date, no pharmacological treatment has been approved for amphetamine abuse or dependence, and psychotherapy remains the best treatment option.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

ALS, which is also known as motor neuron disease (MND), is a condition in which the nerves that control movement stop working. People experience problems moving their limbs, maintaining posture, swallowing, and breathing, which worsen over time and shorten life. The cause is unknown, and there is no cure. People living with ALS/MND often experience fatigue, which can cause distress and reduce quality of life. Fatigue can have many causes, including respiratory problems, medication, malnutrition, and depression. Our focus in this review was on treatments for fatigue that arises from the condition itself. Different treatments may improve symptoms of fatigue in ALS/MND. These include medicines, which may help people feel more awake, and other treatments, such as exercise. It is unclear whether any of these treatments are effective for improving fatigue in ALS/MND. We reviewed the available studies on the effects of treatments for fatigue in ALS/MND.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Background: Traumatic brain injury (TBI) is a major cause of long‐term disability across the world. The disability is often related to chronic cognitive impairment, such as changes to memory, attention and problem solving.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Problems with mental activities (cognitive deficits) are common in patients who have received radiation to the brain for a primary or secondary (metastatic) brain tumour, or to help prevent a tumour spreading to the brain from elsewhere in the body. This toxic side effect of brain radiation may be acute (during treatment) or early after treatment (one to six months) and may be reversible. However, late toxicities may occur many months or years later and are generally irreversible and are slowly progressive. Late cognitive deficits, such as memory loss, problems planning tasks or behavioural changes, can have a serious impact on quality of life and the ability to carrying out activities normally. Interventions to help prevent or treat these late radiation toxicities may improve a patient's well‐being.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

In an advanced disease such as cancer, fatigue can be described as tiredness, weakness or lack of energy. Fatigue can affect daily activity and quality of life, and it is frequently reported by palliative care patients. The underlying causes of fatigue are not very well understood and fatigue is difficult to treat.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

People who work shifts often report sleepiness at work and problems with sleep between work shifts. This is called shift work sleep disorder when the difficulties with sleep after the night shift and sleepiness during the night shift are persistent. We evaluated the effect of drugs, such as melatonin, to improve shift workers' sleep quality after night shift work. We also examined the effect of drugs, such as caffeine, to help shift workers stay awake. We also wanted to evaluate cost‐effectiveness but there were no studies.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Depression is common and under‐treated. The current first‐line drug treatment for moderate or severe depression is antidepressants, but there are problems with their use. This review evaluated the evidence from randomised controlled trials (RCTs) evaluating the effectiveness of psychostimulants (PS) in the treatment of depression. Twenty‐four RCTs were identified, of which 14 had data for meta‐analysis. Five drugs were evaluated, including dexamphetamine, methylphenidate, methylamphetamine, pemoline and modafinil. Modafinil was evaluated separately as its pharmacology differs from other PS. Three small trials of PS involving a total of 62 participants indicated that oral treatment with PS in the short term (up to four weeks) significantly reduced depressive symptoms when compared with placebo, however, the overall quality of the trials was poor, limiting confidence in the findings. Two trials involving 411 participants compared modafinil against placebo when combined with antidepressant treatment at 6‐8 weeks, and showed a non‐significant difference in reducing depression symptoms. One small trial of 50 participants compared oral modafinil against placebo after 12 weeks of treatment, and also showed a non‐significant difference in reducing depression symptoms. No trials examined the longer‐term effect of PS. Further well conducted trials with long term follow‐up are required to find out which PS may be more effective in the treatment of depression, and whether PS are more effective in certain subgroups of depressed patients.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

PPS is a condition that can affect polio survivors years after recovery from an initial paralytic attack by the polio virus. PPS is characterised by progressive or new muscle weakness or decreased muscle endurance in muscles that were previously affected by the polio infection and in muscles that were seemingly unaffected. Other symptoms may include generalised fatigue and pain. These symptoms often lead to a decline in physical functioning, for example trouble walking. The objective of this review was to assess the benefits and harms of different drugs and rehabilitation treatments compared to placebo (a pill or procedure without any physiological effect), usual care or no treatment.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

At least one‐third of people with Parkinson's disease complain about fatigue. It is unclear what treatment is best to reduce fatigue in people with Parkinson's disease.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Attention Deficit Hyperactivity Disorder (ADHD) is a childhood onset psychiatric disorder that can persist into adulthood in up to 50% of patients. From a clinical point of view, ADHD is characterized by hyperactivity, mood instability, irritability, difficulties in maintaining attention, lack of organization and impulsive behaviours. The presence of other disorders occurring at the the same time is also common, especially mood disorders and substance abuse. It seems that amphetamines could reverse the underlying neurological problems that feature in ADHD, and so improve ADHD symptoms.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Sleepiness leads to a deterioration in performance and is associated with an increased risk of error and injury. Shift work is an major cause of sleepiness as it requires workers to be awake at times which are different to those dictated by their 'body clock'. This in turn can compromise the safety of themselves and of others ‐ sleepiness is a risk factor for events such as traffic crashes, occupational injuries and medical errors.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

We investigated whether psychostimulant substitution was safe and effective for treating patients with cocaine dependence.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.