Narcolepsy & its management

This paper discusses the diagnosis and treatment of narcolepsy.

Health-related quality of life in narcolepsy

OBJECTIVES

To describe health-related quality of life in Norwegian patients with narcolepsy compared with data from the general population.

PATIENTS AND METHODS

Seventy-seven patients with narcolepsy with cataplexy were included in the final analysis. Health-related quality of life was assessed by SF-36 questionnaire.

RESULTS

Men and women with narcolepsy had lower scores in all SF-36 domains, except vitality. Most profoundly affected were bodily pain (men: p = 0.0001, women: p = 0.0001), social function (men: p = 0.0001, women: p = 0.0001) and general health (men p = 0.04, women: p = 0.0001).

CONCLUSIONS

Narcolepsy has a clear negative effect on quality of life which is not sufficiently counteracted by medical treatment. We suggest that earlier diagnosis and treatment after onset of symptoms may be important in reducing the negative effects on quality of life. Special attention should be paid to the patients social functioning and general well-being.

Cataplexy associated with narcolepsy: epidemiology, pathophysiology and management

Although narcolepsy was first described over 100 years ago, most of what is known about the pathological changes in the CNS that are responsible for this unusual disease has been learned during the past few years. It is now known that narcolepsy is caused by the loss of a relatively few neurons that are responsible for producing the neuropeptide hypocretin in the CNS. The onset of narcolepsy typically occurs in early adulthood and may consist of a variety of symptoms; however, cataplexy (an abrupt, bilateral loss of skeletal muscle tone) is most specific to narcolepsy. TCAs were found to be beneficial for the treatment of cataplexy over 40 years ago and, more recently, the SSRIs have been used to treat the condition. The recent availability of sodium oxybate (the first drug to receive regulatory approval for the treatment of cataplexy) represents a significant advance in the treatment of narcolepsy, as it is highly efficacious for the treatment of cataplexy and shows promise for the treatment of excessive sleepiness and for improving sleep quality in patients with narcolepsy.

Narcolepsy: a review of evidence for autoimmune diathesis

Sporadic narcolepsy with cataplexy is a disabling disease that is strongly associated with the major histocompatibility class II allele HLA DQB1*0602 and is characterized by profound reduction in the cerebrospinal fluid (CSF) concentration of hypocretin 1 levels. This article provides a comprehensive review of the evidence that neurologic autoimmunity is the pathogenic basis of narcolepsy with cataplexy. Despite this evidence, specific antibody markers for narcolepsy have been elusive. Clinical trials using intravenous immunoglobulin infusions in recent onset narcolepsy with cataplexy have led to improvement in cataplexy in some patients. Future research must focus on elucidation of immune markers and early ameliorative treatments for narcolepsy.

Successful treatment of narcolepsy and cataplexy: a review

A 25-year-old woman with narcolepsy and cataplexy was treated with well-recognized drugs for these conditions. Because she did not respond, a decision was made to treat her with sodium oxybate.

The nurse role in managing and treating sleep disorders

Obstructive sleep apnoea/hypopnoea syndrome affects a significant number of middle-aged people. By causing the person with the condition to wake repeatedly during the night in order to restart breathing, it causes excessive daytime sleepiness and impairs cognitive function and driving ability. It can also adversely affect family relationships, particularly with partners whose sleep may also be disturbed. Nurses have a role in the diagnosis and management of the condition through appropriate questioning, observation, advice on lifestyle choices, and support for treatment. The article also focuses on narcolepsy.

Emerging Therapies in Narcolepsy-Cataplexy

In the past, narcolepsy was primarily treated using amphetamine-like stimulants and tricyclic antidepressants. Newer and novel agents, such as the wake-promoting compound modafinil and more selective reuptake inhibitors targeting the adrenergic, dopaminergic, and/or serotoninergic reuptake sites (ie, venlafaxine, atomoxetine) are better-tolerated available alternatives. The development of these agents, together with sodium oxybate (a slow-wave sleep-enhancing agent that consolidates nocturnal sleep, reduces cataplexy, and improves sleepiness), has led to improved functioning and quality of life for many patients with the disorder. However, these treatments are all symptomatically based and do not target hypocretin, a major neurotransmitter involved in the pathophysiology of narcolepsy. In this review, we discuss emerging therapies in the area of narcolepsy. These include novel antidepressant or anticataplectic, wake-promoting, and hypnotic compounds. We also report on novel strategies designed to compensate for hypocretin deficiency and on the use of immunosupression at the time of narcolepsy onset.

Sleep Disorders in Multiple Sclerosis

Sleep disorders are pervasive in patients with multiple sclerosis (MS) although clinically underrecognized by most physicians. The most common sleep disorders seen in patients with MS include insomnia, nocturnal movement disorders, sleep-disordered breathing, narcolepsy, and rapid eye movement sleep behavior disorder. Factors that influence the quality of sleep in this patient population include pain, nocturia, depression, medication effect, location of lesions, and disease severity. Disrupted sleep has the potential to cause daytime somnolence, increased fatigue, and nonrefreshing sleep, and it may be associated with dangerous respiratory events. Awareness and treatment of these conditions is vital to improving health and quality of life in patients with MS.

Falsche Perlen... Imperative Tagesschläfrigkeit – ein Erlebnisbericht

Ausgehend vom persönlichen Erleben einer Narkolepsie, insbesondere von imperativer Tagesschläfrigkeit und Kataplexien, wird dieses zweifellos zu selten beachtete und oft verdrängte Krankheitsbild beschrieben. Die ökonomische (Vermeiden von Arbeitsunfähigkeit) und ethische (Straßenverkehr!) Dimension der Krankheit ist sehr groß.

Functional status in patients with narcolepsy

OBJECTIVE

To describe health and functional status in treated narcolepsy patients and to compare it with normative data and with patients with another cause of sleepiness, the obstructive sleep apnea/hypopnea syndrome (OSAHS) patients.

METHODS

A functional status survey in narcolepsy patients and in symptomatic untreated and CPAP treated OSAHS patients with an apnea-hypopnea index (AHI) >5 was assessed using the UK Short Form 36 (SF-36) questionnaire, the Functional Outcomes of Sleep Questionnaire (FOSQ) and the Epworth Sleepiness Scale (ESS). SF-36 scores in narcoleptics were compared to age and sex matched controls. Narcolepsy patients also replied to a psychosocial aspects questionnaire. Health history and demographic data were obtained via a review of medical records and postal survey.

RESULTS

Forty-nine treated narcolepsy patients, 56 untreated OSAHS and 48 CPAP treated OSAHS patients attending the sleep disorders clinic were recruited for this study. Narcoleptics presented significantly lower scores in all SF-36 domains compared to normative data. No difference in SF-36 scores was found between narcoleptics and untreated OSAHS patients but narcoleptics were sleepier and had lower FOSQ scores. These treated narcolepsy patients had lower scores in two dimensions of the SF-36 and in all FOSQ domains compared to CPAP-treated OSAHS patients.

CONCLUSIONS

Functional status in treated narcoleptics is poor.

[Sleep disorders and sleep-related breathing disorders]

Normal sleep consists of 4-5 sleep cycles including light-, deep- and rapid eye-movement sleep. Restoration of physical and psychological function are the main effects of sleep. In most cases, disturbances of normal sleep become clinically evident as problems of initiating and maintaining sleep and/or as increased daytime sleepiness. Approximately 10% of adults suffer from pronounced insomnia, a similar percentage from markedly increased daytime sleepiness. Sleep disorders cause high socio-economic costs due to increased accident risk, cardiovascular sequelae and sick leave. Most of the 88 distinct diagnoses summarized in the international classification of sleep disorders can be differentiated and managed according to patients history. In patients with severe daytime sleepiness - sleep disordered breathing being the most frequent cause - the diagnostic evaluation and treatment in the sleep laboratory is required. Effective therapeutic strategies are available for many sleep disorders. According to the underlying disorder, treatment includes a variety of measures like life style changes, differentiated medical treatment and the use of nasally applied positive pressure in patients suffering from sleep disordered breathing.

Orexin peptides prevent cataplexy and improve wakefulness in an orexin neuron-ablated model of narcolepsy in mice

Narcolepsy-cataplexy is a neurological disorder associated with the inability to maintain wakefulness and abnormal intrusions of rapid eye movement sleep-related phenomena into wakefulness such as cataplexy. The vast majority of narcoleptic-cataplectic individuals have low or undetectable levels of orexin (hypocretin) neuropeptides in the cerebrospinal fluid, likely due to specific loss of the hypothalamic orexin-producing neurons. Currently available treatments for narcolepsy are only palliative, symptom-oriented pharmacotherapies. Here, we demonstrate rescue of the narcolepsy-cataplexy phenotype of orexin neuron-ablated mice by genetic and pharmacological means. Ectopic expression of a prepro-orexin transgene in the brain completely prevented cataplectic arrests and other abnormalities of rapid eye movement sleep in the absence of endogenous orexin neurons. Central administration of orexin-A acutely suppressed cataplectic behavioral arrests and increased wakefulness for 3 h. These results indicate that orexin neuron-ablated mice retain the ability to respond to orexin neuropeptides and that a temporally regulated and spatially targeted secretion of orexins is not necessary to prevent narcoleptic symptoms. Orexin receptor agonists would be of potential value for treating human narcolepsy.

Narcolepsy and Syndromes of Primary Excessive Daytime Somnolence

Excessive daytime sleepiness (EDS) or somnolence is common in our patients and in society in general. The most common cause of EDS is "voluntary" sleep restriction. Other common causes include sleep-fragmenting disorders such as the obstructive sleep apnea syndrome. Somewhat less familiar to the clinician are EDS conditions arising from central nervous system dysfunction. Of these so-called primary disorders of somnolence, narcolepsy is the most well known and extensively studied, yet often misunderstood and misdiagnosed. Idiopathic hypersomnia, the recurrent hypersomnias, and EDS associated with nervous system disorders also must be well-understood to provide appropriate evaluation and management of the patient with EDS. This review summarizes the distinguishing features of these clinical syndromes of primary EDS. A brief overview of the pharmacological management of primary EDS is included. Finally, in view of the tremendous advances that have occurred in the past few years in our understanding of the pathophysiology of canine and human narcolepsy, we also highlight these discoveries.