Modafinil‐Induced Hyperkinetic Movements in Post‐Stroke Patients: A Case Series

Background Modafinil is a wakefulness‐promoting agent used off‐label for post‐stroke hypersomnolence. Although generally well‐tolerated, rare central nervous system adverse effects, including hyperkinetic movement disorders, have been reported. Cases We describe three elderly male stroke patients who developed new‐onset involuntary movements within 48 h of initiating modafinil (100 mg/day) during recovery. Movements were choreiform or irregular, present during wakefulness, and absent during sleep. Extensive metabolic, neuroimaging, and electrophysiological evaluations revealed no alternative cause. Symptoms resolved completely within 36–48 h of discontinuing modafinil. Conclusions Modafinil may rarely induce reversible hyperkinetic movements in elderly stroke patients. Clinicians should monitor for abnormal movements during its use, particularly in neurologically vulnerable individuals.