Amphetamine, mazindol, and fencamfamin in narcolepsy

Twenty patients with the narcoleptic syndrome were treated separately with dexamphetamine sulphate tablets 10 and 30 mg, Dexedrine Spansules 10 mg, mazindol 4 mg, and fencamfamin hydrochloride 60 mg daily. Each drug was given for four weeks and the effects compared. In these dosages the reported frequency of attacks of narcolepsy was roughly halved with each treatment, dexamphetamine 30 mg daily being only slightly more potent than 10 mg. The subjective effects of Dexedrine tablets and Spansules could not be distinguished by most patients. Effects on mood, alertness, and sympathomimetic side effects were largely inseparable with all these drugs, but a decrease in appetite was not reported by patients with narcolepsy.

[Advances in the psychopharmacological management of the narcoleptic patient]

Sleep attacks, cataplexy, sleep paralysis and hypnagogic hallucinations are the cardinal signs of narcolepsy. However most patients present only with sleep attacks at disease onset. Animal and human studies on the psychopharmacology and neurochemistry of narcolepsy, suggest abnormalities on rapid eye movement (REM) sleep. Thus, most drugs used on its treatment, such as tricyclic antidepressants and psychostimulant agents, are aimed to reduce REM sleep. However, there is growing evidence that some drugs that can alleviate fragmentation of sleep rather than suppress REM sleep can also be clinically effective for this condition. The authors review the subject and comment on their experience with clonidine, an imidazoline derivative marketed as an antihypertensive agent, and suggest that REM suppression is not always necessary for narcoleptics to improve.

Does memory impairment exist in narcolepsy-cataplexy?

Approximately one-half of patients with the narcolepsy-cataplexy syndrome suffer from subjective memory problems, mainly involving recent events. Ten untreated narcoleptic patients (7 male, 3 female, aged 28-65 years) with such problems and 10 matched controls were given a battery of tests to study the complaint. Tests included the digit span, Knox cube, recurring figures (verbal and nonverbal), visual reproduction, paired associates learning and logical memory test, plus naming and fluency tests to control for language capabilities. No significant intergroup differences were found. It is concluded that narcoleptics do not have a true organic memory deficit, but rather experience a subjective problem due to drowsiness which they are able to suppress during short testing sessions in a laboratory environment.

Efficacy of trazodone in narcolepsy

A 25-year-old man with narcolepsy and cataplexy experienced partial relief of symptomatology following administration of methylphenidate. Moreover, the latter caused extreme agitation and aggression. However, administration of the antidepressant agent trazodone resulted in almost complete alleviation of the narcoleptic and cataplectic attacks within 48 h after initiation of therapy. Trazodone, a novel antidepressant agent may be useful in the long-term management of individuals suffering from narcolepsy.

The neurobiology of the narcoleptic syndrome

Relevant electroencephalographic, psychopharmacologic, and genetic research reports are described in support of a neurobiological explanation of the narcoleptic syndrome. Despite increased support in this realm, no single neurobiological theory has won unanimous approval among sleep researchers, which has led toward speculation that the condition may be heterogeneous in nature. A multifactorial perspective, including psychological as well as neurobiological influences, appears to be the most productive model for research. Future investigation of sleep disorders utilizing such a model may enhance the understanding of neurobiological correlates of behavioural disorders.

Monoamine oxidase-inhibiting antidepressants. A clinical update

This article outlines the latest information on the clinical efficacy of MAOIs and provides the physician with guidelines for their safe use. The important side effects of this class of drugs are also summarized along with an up-to-date account of their possible molecular mechanism of action.

Narcolepsy, paranoid psychosis, major depression, and tardive dyskinesia

This report describes a man with narcolepsy, paranoid psychosis, major depression, and tardive dyskinesia. The case illustrates the treatment difficulties such a patient presents and also raises questions about interactions between the putative neurotransmitters involved in each of these conditions. It is suggested that the presence of narcolepsy may facilitate the appearance of unwanted effects of antidepressants and neuroleptics such as psychosis and depression.

Heterocyclic antidepressants in nonpsychiatric disorders

Heterocyclic antidepressants have been used successfully in the treatment of migraine, enuresis and encopresis, peptic ulcer disease, irritable bowel syndrome, chronic pain, narcolepsy, sleep apnea and attention deficit disorder. The mechanism of their therapeutic effects in these conditions is still unclear. Serotonergic, noradrenergic, anticholinergic and antihistaminic properties and rapid-eye-movement sleep suppression have been implicated.

Effects of arginine vasotocin on REM sleep in narcoleptics and in symptomatic hypersomniacs

Arginine vasotocin (AVT), in doses of 1.5 microgram, administered intranasally to two narcoleptics (a male aged 42 years and a female aged 35 years), as well as to 5 symptomatic hypersomniacs (3 females and 2 males), aged 25-57 years, induced very rapidly in most instances in sleep with REM periods at onset and markedly increased in amount of REM sleep during a fixed period of 180 min of sleep recording. After AVT administration there was a significant shortening of the time of occurrence of the first REM sleep period both in narcoleptics (t test = 0.05 greater than P greater than 0.025) and in symptomatic hypersomniacs (t test = 0.02 greater than P greater than 0.01).

Narcolepsy-cataplexy. I. Clinical and electrophysiologic characteristics

The development, clinical course, and electrophysiologic characteristics of narcolepsy were evaluated in 50 adults who had a current complaint of sleep attacks and cataplexy. In most of the patients, the first symptoms, usually excessive daytime sleepiness and sleep attacks, developed during childhood or adolescence. The condition was invariably chronic. Patients frequently had family histories of some disorder of excessive daytime sleepiness. In nocturnal sleep or daytime nap recordings, all but three of the patients demonstrated a rapid-eye-movement (REM) period at sleep onset. Sleep apnea was found in only one patient. Our findings indicate that sleep laboratory recordings to detect a sleep-on-set REM period are of little diagnostic value when the narcoleptic patient has cataplexy. Furthermore, narcoleptic patients require sleep laboratory evaluation for sleep apnea only when the presence of apnea is suggested by the sleep history.

[Sleeping sickness in children and its long term after-effects. Apropos 110 personal observations at Fontem Hospital (Cameroon)]

This study has been conducted in Fontem hospital (Cameroon). In the first part, the author describes the clinical symptoms leading to the diagnosis : change in the general condition, headache, fever and sleeping disorder are starting symptoms, which are rarely observed in the youngest children. One child out of three has encephalic troubles such as altered motor development or psycho-neurotic disorders. Motor troubles affect only children in the cerebral polarisation phase. The second part of this paper considers the sequellae observed in 120 children: half of them are affected but 12 p. 100 are seriously handicapped. Slow psychomotor development and psychoneurotic troubles exist in 11,5 p. 100 of the children, even for those a diagnosis was made at an early stage. Adversely a late diagnosis is responsible of severe motor sequellae in 6,5 p. 100 of all the young patients.

Treatment of narcolepsy and sleep apnea with gammahydroxybutyrate: a clinical and polysomnographic case study

Gammahydroxybutyrate was administered to a patient who experienced narcolepsy associated with central sleep apnea. The treatment relieved the major symptoms of narcolepsy, and significantly decreased the number of apneic periods. Gammahydroxybutyrate did not cause the prolonged and potentially fatal apneic periods associated with the use of other hypnotic agents.