Type 2 narcolepsy treatment11/22/2023 ![]() Randomized trial of modafinil as a treatment for the excessive daytime somnolence of narcolepsy: US Modafinil in Narcolepsy Multicenter Study Group. Randomized, double-blind, placebo-controlled crossover trial of modafinil in the treatment of excessive daytime sleepiness in narcolepsy. 1994 17:S107–12.īroughton RJ, Fleming JA, George CF, Hill JD, Kryger MH, Moldofsky H, et al. Modafinil: a double-blind multicentric study. A recent review about management strategies in narcolepsy.īilliard M, Besset A, Montplaisir J, Laffont F, Goldenberg F, Weill JS, et al. Predictors of hypocretin (orexin) deficiency in narcolepsy without cataplexy. 2013 9:789–95.Īndlauer O, Moore H, Hong S-C, Dauvilliers Y, Kanbayashi T, Nishino S, et al. Test-retest reliability of the multiple sleep latency test in narcolepsy without cataplexy and idiopathic hypersomnia. ICSD-2: International Classification of Sleep Disorders, 2d ed. A recent review article about symptoms and diagnosis of narcolepsy.ĪASM. Prevalence of narcolepsy symptomatology and diagnosis in the European general population. Ohayon MM, Priest RG, Zulley J, Smirne S, Paiva T. Narcolepsy as an autoimmune disease: the role of H1N1 infection and vaccination. Partinen M, Kornum BR, Plazzi G, Jennum P, Julkunen I, Vaarala O. This recent classification is the reference for the diagnosis of sleep disorders worldwide. ICSD-3: International Classification of Sleep Disorders, 3rd ed. Papers of particular interest, published recently, have been highlighted as ĪASM: American Academy of Sleep Medicine. Immune-based therapies are other possibilities in NT1, at disease onset, with already some successful attempts to slow down or stop the autoimmune process. In the future, Hcrt replacement or Hcrt agonists will certainly be options to treat NT1, but for now the different peptides do not cross easily the blood brain barrier. A clinically relevant tool is required to quantify the severity of narcolepsy, subjective symptoms, and their consequences, to monitor the treatment efficacy, and to finally optimize narcolepsy management. However, antidepressant agents such as venlafaxine are also commonly used, with few adverse effects and a good efficacy, although based on expert consensus only. First-line strategy is the use of sodium oxybate, the only drug approved for cataplexy and EDS in adults. ![]() Furthermore, cataplexy treatment should not be systematic. We advise to wait a few weeks with a stimulant drug before starting an anticataplectic treatment in NT1, except for severe cataplexy. Sodium oxybate has the advantage to be also effective to manage the fragmented nocturnal sleep, another common symptom in NT1. First-line medications should be stimulants such as modafinil, armodafinil, or sodium oxybate, second-line methylphenidate and pitolisant, where available, and amphetamines as third-line therapy. ![]() The main symptom in both diseases is a disabling excessive daytime sleepiness (EDS). We recommend that medications and guidelines in NT2 should be the same as for NT1 (except for cataplexy), but the benefit risk ratio should be reassessed regularly. Management strategies are rather codified, at least in adults, with a lifelong treatment required in NT1, whereas no pharmacological study focused only on NT2 patients, with sometimes spontaneous improvement or disappearance of their symptoms. ![]() ![]() On the contrary, little is known about NT2 etiology, sharing with NT1 somnolence and signs of dysregulation of rapid eye movement (REM) sleep, but not cataplexy. The pathophysiology of NT1 is well known it is caused by the selective destruction of hypocretin (Hcrt) neurons, by a highly suspected autoimmune process. Narcolepsy type 1 (NT1) and type 2 (NT2) are two rare neurological diseases, classified as central disorders of hypersomnolence. ![]()
0 Comments
Leave a Reply.AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |