![]() Narcolepsy has a negative impact on several aspects of life such as driving ability, professional performance, familial equilibrium, and mood ( Broughton et al 1981). Hypnagogic hallucinations and sleep paralysis are most often transient. ![]() Cataplexy may vanish spontaneously in some patients. The pattern tends to be for EDS and irresistible sleep attacks to persist throughout life, even if improvements are commonly observed after retirement, probably in part due to a better schedule of sleep and activity. The general course of narcolepsy is hard to systematize. The age of onset varies from early childhood to 50, with a bimodal distribution, including a main peak around the age of 15 and a secondary peak around the age of 36 ( Dauvilliers et al 2001). Narcolepsy due to medical condition is exceptional, with 115 cases published in the world literature ( Nishino and Kanbayashi 2005). Narcolepsy without cataplexy is thought to represent between 10% and 50% of all narcolepsy cases, but the precise prevalence is unknown. Limited data suggest that the incidence is 0.74 per 100,000 person-years ( Silber et al 2002)). The prevalence of narcolepsy with cataplexy is estimated to be 0.02%–0.05% ( Hublin et al 1994a Ohayon et al 2002 Silber et al 2002 Wing et al 2002). Recently the second edition of the International Classification of Sleep Disorders (ICSD-2) has recognized three forms of narcolepsy: narcolepsy with cataplexy, narcolepsy without cataplexy, and narcolepsy due to medical condition ( American Academy of Sleep Medicine 2005). However, polysomnography followed by a multiple sleep latency test (MSLT) is greatly recommended to document a mean sleep latency ≤8 min and two or more sleep onset REM periods ( American Academy of Sleep Medicine 2005). The diagnosis of narcolepsy rests on clinical grounds. The cardinal symptoms are excessive daytime sleepiness/sleep attacks and cataplexy. Narcolepsy is a disabling condition characterized by three groups of symptoms: excessive daytime sleepiness (EDS) and irresistible sleep episodes, plus or minus automatic behaviors cataplexy, a sudden loss of muscle tone triggered by strong emotions such as laughter or humorous experiences, and other abnormal rapid eye movement (REM) sleep manifestations, sleep paralysis and hypnagogic hallucinations disturbed nocturnal sleep, and parasomnias. Careful titration up to an adequate level is essential both to obtain positive results and avoid adverse effects 3) A series of new treatments are currently being tested, either in animal models or in humans, They include novel stimulant and anticataplectic drugs, endocrine therapy, and, more attractively, totally new approaches based on the present state of knowledge of the pathophysiology of narcolepsy with cataplexy, hypocretine-based therapies, and immunotherapy. ![]() This treatment has a fairly good efficacy and is active on all symptoms of narcolepsy. For cataplexy, sleep paralysis, and hypnagogic hallucinations, new antidepressants tend to replace tricyclic antidepressants and selective serotonin reuptake inhibitors (SSRIs) in spite of a lack of randomized, double blind, placebo-controlled clinical trials of these compounds 2) The conventional treatment of narcolepsy is now challenged by sodium oxybate, the sodium salt of gammahydroxybutyrate, based on a series of randomized, double-blind, placebo-controlled clinical trials and a long-term open label study. Modafinil has replaced methylphenidate and amphetamine as the first-line treatment of excessive daytime sleepiness (EDS) and sleep attacks, based on randomized, double blind, placebo-controlled clinical trials of modafinil, but on no direct comparison of modafinil versus traditional stimulants. Three main avenues are considered in this review: 1) Two tendencies characterize the conventional treatment of narcolepsy. The management of narcolepsy is presently at a turning point.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |