by Peter Goodin

In science, collaboration is key. Collaboration leads to discussion, which can lead to new ideas, discoveries or breakthroughs. Collaboration has the potential to allow us to see our field through new eyes and make connections where we were unable to see them before.

Recently, thanks to the collaboration between The Florey Institute of Neuroscience and Mental Health, the Hunter Medical Research Institute (HMRI), as part of the Centre for Research Excellence in Stroke Rehabilitation and Brain Recovery, and the generous support of the James S. McDonnell Foundation I was given the opportunity to apply an analysis method I developed to explore how brain regions connect to each other in post-stroke fatigue using functional magnetic resonance imaging (fMRI).

Post-stroke fatigue is a poorly understood condition that is estimated to affect approximately 30% of the stroke survivor population. Excessive tiredness not related to physical or mental activity, diminished cognitive ability and changes to emotion stability are commonly reported symptoms in stroke survivors which limit an individual’s ability to participate in the activities of daily living or continue employment. Modafinil, originally designed to help those with Narcolepsy remain awake and alert, has found a potential new target in assisting those who suffer from post-stroke fatigue. The results of the Modafinil In Debilitating Fatigue After Stroke (MIDAS) clinical trial show decreased fatigue and improved quality of life with Modafinil therapy. Broadly speaking, Modafinil works by stimulating of a broad range of neurotransmitters (the monoaminergic system), of which orexin is the most interesting because it is directly linked with attention and alertness.

Working closely with the trial co-ordinator Dr Andrew Bivard, an expert in acute stroke neuroimaging and Milanka Visser, Andrew’s talented PhD student, we applied my method to explore how the brain reacted to modafinil and how the connections between various regions of the brain changed when MIDAS trial participants were treated with Modafinil.

 Preliminary outcomes look promising. We’ve found Modafinil has the potential to strengthen connections within the brain in regions involved with switching focus between external and internal attention. Interestingly, my research into brain changes during rehabilitation of tactile sensation post-stroke with Professor Leeanne Carey also suggests a link with attention.

Could changes to attention impact outcomes after stroke? By retraining or boosting attention could we aide alertness and recovery? We’re not sure yet. But it’s a potential avenue worth exploring, and a link that may have taken some time to uncover without the collaboration between the Florey and HMRI.