Cognitive Behavioral Therapy, Modafinil, or Both for Multiple Sclerosis Fatigue

Inclusion Criteria:

1. Patients with clinically definite Multiple Sclerosis (MS, all MS subtypes);

2. Age 18 years or older;

3. Presence of chronic, problematic fatigue that, in the opinion of the patient, has
interfered with their daily activities for ≥ 3 months;

4. Average Fatigue Severity Scale (FSS) score greater or equal to 4 at screening.

Exclusion Criteria:

1. Current shift work sleep disorder, or narcolepsy diagnosed with polysomnography and
multiple sleep latency test

2. History of MS relapse within the last 30 days prior to screening (participants will be
considered eligible after the 30-day window);

3. Current stimulant or wake-promoting agent use (such as amantadine, modafinil,
methylphenidate, or amphetamine) within 30 days of screening;

4. Pregnancy or breastfeeding;

5. Reliance on hormonal contraception AND concomitant unwillingness to use alternative
non-hormonal means of birth control (spermicide or condoms) during the course of the
study;

6. Current suicidal ideation (SI) with intent or plan;

7. Known hypersensitivity to modafinil or armodafinil or its inactive ingredients;

8. History of the following cardiovascular conditions: recent myocardial infarction (last
6 months prior to screening), unstable angina, left ventricular hypertrophy, mitral
valve prolapse, NYHA class III or IV congestive heart failure;

9. History of prescription or illicit stimulant abuse (such as cocaine, amphetamine,
methamphetamine);

10. Any other medical, neurological, or psychiatric condition that, in the opinion of the
investigators, could affect participant safety or eligibility.