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Boulanger T, Pigeon P, Crawford S. Diagnostic challenges and burden of idiopathic hypersomnia: a systematic literature review. SLEEP ADVANCES : A JOURNAL OF THE SLEEP RESEARCH SOCIETY 2024; 5:zpae059. [PMID: 39211350 PMCID: PMC11359170 DOI: 10.1093/sleepadvances/zpae059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 07/23/2024] [Indexed: 09/04/2024]
Abstract
Idiopathic hypersomnia (IH) is a rare neurological sleep disorder, characterized by excessive daytime sleepiness despite normal sleep duration, that can significantly impact patient's lives. The burden of IH goes beyond excessive daytime sleepiness, pervading all aspects of everyday life. Characteristic and burdensome symptoms of IH include sleep inertia/drunkenness, long sleep duration, and daytime cognitive dysfunction. This systematic review assessed current knowledge regarding IH diagnostic challenges and burden of illness. Literature searches for original epidemiological, clinical, humanistic, or economic research relevant to IH published between 2012 and 2022 in MEDLINE, Embase, Cochrane, gray literature (diagnostic criteria and treatment guidelines), conferences (2019-2022), and clinical trial databases yielded 97 articles. Findings indicate that IH remains a poorly defined diagnosis of exclusion that is difficult to distinguish from narcolepsy type 2 because of symptom overlap and inadequacies of objective testing. Consequently, individuals with IH endure diagnostic delays of up to 9 years. The economic burden of IH has not been characterized to any appreciable extent. Pharmacological treatment options can improve symptoms and functional status, but rarely restores normal levels of functioning. These findings highlight the need to reclassify central disorders of hypersomnolence. Further collaboration is now required between research groups to identify and validate objective markers to help redefine diagnostic criteria for IH. This would move IH into a position that could benefit from future targeted therapeutic interventions. The study was funded by Takeda Development Center Americas, Inc.
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Abstract
Idiopathic hypersomnia (IH) and Kleine-Levin syndrome (KLS) are rare disorders of central hypersomnolence of unknown cause, affecting young people. However, increased sleep time and excessive daytime sleepiness (EDS) occur daily for years in IH, whereas they occur as relapsing/remitting episodes associated with cognitive and behavioural disturbances in KLS. Idiopathic hypersomnia is characterized by EDS, prolonged, unrefreshing sleep at night and during naps, and frequent morning sleep inertia, but rare sleep attacks, no cataplexy and sleep onset in REM periods as in narcolepsy. The diagnosis requires: (i) ruling out common causes of hypersomnolence, including mostly sleep apnea, insufficient sleep syndrome, psychiatric hypersomnia and narcolepsy; and (ii) obtaining objective EDS measures (mean latency at the multiple sleep latency test≤8min) or increased sleep time (sleep time>11h during a 18-24h bed rest). Treatment is similar to narcolepsy (except for preventive naps), including adapted work schedules, and off label use (after agreement from reference/competence centres) of modafinil, sodium oxybate, pitolisant, methylphenidate and solriamfetol. The diagnosis of KLS requires: (i) a reliable history of distinct episodes of one to several weeks; (ii) episodes contain severe hypersomnia (sleep>15h/d) associated with cognitive impairment (mental confusion and slowness, amnesia), derealisation, major apathy or disinhibited behaviour (hypersexuality, megaphagia, rudeness); and (iii) return to baseline sleep, cognition, behaviour and mood after episodes. EEG may contain slow rhythms during episodes, and rules out epilepsy. Functional brain imaging indicates hypoactivity of posterior associative cortex and hippocampus during symptomatic and asymptomatic periods. KLS attenuates with time when starting during teenage, including less frequent and less severe episodes. Adequate sleep habits, avoidance of alcohol and infections, as well as lithium and sometimes valproate (off label, after agreement from reference centres) help reducing the frequency and severity of episodes, and IV methylprednisolone helps reducing long (>30d) episode duration.
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Affiliation(s)
- I Arnulf
- Sorbonne Université, Paris, France; Centre de Référence des narcolepsies et hypersomnies rares, Service des pathologies du sommeil, Hôpital Pitié-Salpêtrière, AP-HP Sorbonne Université, Paris, France; Institut du Cerveau (ICM), Paris Brain Institute, Paris, France.
| | - P Dodet
- Centre de Référence des narcolepsies et hypersomnies rares, Service des pathologies du sommeil, Hôpital Pitié-Salpêtrière, AP-HP Sorbonne Université, Paris, France; Institut du Cerveau (ICM), Paris Brain Institute, Paris, France
| | - S Leu-Semenescu
- Centre de Référence des narcolepsies et hypersomnies rares, Service des pathologies du sommeil, Hôpital Pitié-Salpêtrière, AP-HP Sorbonne Université, Paris, France; Institut du Cerveau (ICM), Paris Brain Institute, Paris, France
| | - J B Maranci
- Sorbonne Université, Paris, France; Centre de Référence des narcolepsies et hypersomnies rares, Service des pathologies du sommeil, Hôpital Pitié-Salpêtrière, AP-HP Sorbonne Université, Paris, France; Institut du Cerveau (ICM), Paris Brain Institute, Paris, France
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Blattner M, Maski K. Central Disorders of Hypersomnolence. Continuum (Minneap Minn) 2023; 29:1045-1070. [PMID: 37590822 DOI: 10.1212/con.0000000000001265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
OBJECTIVE The goals of this article are to describe the clinical approach to and management of patients with central disorders of hypersomnolence, and to understand and differentiate available diagnostic tools. LATEST DEVELOPMENTS Updated clinical practice guidelines for the treatment of central disorders of hypersomnolence and narcolepsy specifically highlight new treatment options. Approval for a lower-sodium oxybate formulation that contains 92% less sodium than the standard sodium oxybate for the treatment of narcolepsy and idiopathic hypersomnia adds to the number of medications available for these disorders, allowing for a more tailored management of symptoms. ESSENTIAL POINTS Central disorders of hypersomnolence are characterized by excessive daytime sleepiness that impacts daily functions. These disorders can be differentiated by obtaining a detailed clinical sleep history and by a thoughtful interpretation of sleep diagnostic testing. Tailoring treatment approaches to meet the needs of individuals and accounting for medical and psychiatric comorbidities may improve quality of life.
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Arnulf I, Thomas R, Roy A, Dauvilliers Y. Update on the treatment of idiopathic hypersomnia: Progress, challenges, and expert opinion. Sleep Med Rev 2023; 69:101766. [PMID: 36921459 DOI: 10.1016/j.smrv.2023.101766] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 12/13/2022] [Accepted: 02/20/2023] [Indexed: 02/27/2023]
Abstract
Idiopathic hypersomnia is a central hypersomnolence disorder of unknown origin characterized by excessive daytime sleepiness despite normal or long sleep time, and frequent severe sleep inertia. Management strategies have been largely derived from expert consensus, due to a lack of disease-specific assessments and reliance on case series and rare randomized controlled studies. Guidelines recommend treatment with off-label medications. Modafinil, which was approved for idiopathic hypersomnia until 2011 in Europe, is the most commonly used treatment and improved sleepiness in two recent randomized placebo-controlled trials. In 2021, low-sodium oxybate (LXB) was approved in the United States for idiopathic hypersomnia. In a placebo-controlled, double-blind, randomized withdrawal study, LXB reduced daytime sleepiness and sleep inertia, and improved daily functioning. Here, treatment options are reviewed considering the authors' professional experience, current guidelines, and the latest research developments. The choice of pharmacotherapy should be guided by symptom profile, age, comorbidities (eg, depressive symptoms, cardiovascular problems), and concomitant medications (eg, oral contraceptives). Nonpharmacologic approaches have a role in management. An instrument (idiopathic hypersomnia severity scale) has been validated in idiopathic hypersomnia specifically, opening a path to better assessment of symptoms, impact, and response to treatment. Continued research on idiopathic hypersomnia is needed to support treatment algorithms.
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Affiliation(s)
- Isabelle Arnulf
- Sleep Disorder Unit, Pitié-Salpêtrière Hospital and Sorbonne University, Paris, France; National Reference Network for Orphan Diseases: Narcolepsy and Rare Hypersomnias, Paris, France.
| | - Robert Thomas
- Department of Medicine, Division of Pulmonary, Critical Care & Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Asim Roy
- Ohio Sleep Medicine Institute, Dublin, OH, USA
| | - Yves Dauvilliers
- National Reference Network for Orphan Diseases: Narcolepsy and Rare Hypersomnias, Paris, France; Sleep and Wake Disorders Centre, Department of Neurology, Gui de Chauliac Hospital, Montpellier, France; University of Montpellier, INSERM Institute Neuroscience Montpellier (INM), Montpellier, France
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Abstract
Idiopathic hypersomnia (IH) includes a clinical phenotype resembling narcolepsy (with repeated, short restorative naps), and a phenotype with an excess of sleep, sleep drunkenness, drowsiness, and infrequent long, nonrestorative naps. Sleep tests reflect this heterogeneity. MSLTs are greater than 8 min in 2/3 of the cases and poorly repeatable. Sleep excess is better captured by extended monitoring identifying 11 to 16h of sleep/24 h. Patients with IH are young and more often female. Possible mechanisms of IH include deficiencies in arousal systems, inappropriate stimulation of sleep-inducing systems, and long biological night. Treatments now include robust studies of modafinil, clarithromycin, and sodium oxybate.
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Affiliation(s)
- Isabelle Arnulf
- Service des pathologies du sommeil, Hopital Pitie-Salpetriere, 83 boulevard de l'Hopital, Paris 75013, France; Sorbonne University, Paris, France.
| | - Smaranda Leu-Semenescu
- Service des pathologies du sommeil, Hopital Pitie-Salpetriere, 83 boulevard de l'Hopital, Paris 75013, France
| | - Pauline Dodet
- Service des pathologies du sommeil, Hopital Pitie-Salpetriere, 83 boulevard de l'Hopital, Paris 75013, France
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Maski K, Trotti LM, Kotagal S, Robert Auger R, Swick TJ, Rowley JA, Hashmi SD, Watson NF. Treatment of central disorders of hypersomnolence: an American Academy of Sleep Medicine systematic review, meta-analysis, and GRADE assessment. J Clin Sleep Med 2021; 17:1895-1945. [PMID: 34743790 DOI: 10.5664/jcsm.9326] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
INTRODUCTION This systematic review provides supporting evidence for the accompanying clinical practice guideline on the treatment of central disorders of hypersomnolence in adults and children. The review focuses on prescription medications with U.S. Food & Drug Administration approval and nonpharmacologic interventions studied for the treatment of symptoms caused by central disorders of hypersomnolence. METHODS The American Academy of Sleep Medicine commissioned a task force of experts in sleep medicine to perform a systematic review. Randomized controlled trials and observational studies addressing pharmacological and nonpharmacological interventions for central disorders of hypersomnolence were identified. Statistical analyses were performed to determine the clinical significance of all outcomes. Finally, the Grading of Recommendations Assessment, Development and Evaluation (GRADE) process was used to assess the evidence for the purpose of making specific treatment recommendations. RESULTS The literature search identified 678 studies; 144 met the inclusion criteria and 108 provided data suitable for statistical analyses. Evidence for the following interventions is presented: armodafinil, clarithromycin, clomipramine, dextroamphetamine, flumazenil, intravenous immune globulin (IVIG), light therapy, lithium, l-carnitine, liraglutide, methylphenidate, methylprednisolone, modafinil, naps, pitolisant, selegiline, sodium oxybate, solriamfetol, and triazolam. The task force provided a detailed summary of the evidence along with the quality of evidence, the balance of benefits and harms, patient values and preferences, and resource use considerations. CITATION Maski K, Trotti LM, Kotagal S, et al. Treatment of central disorders of hypersomnolence: an American Academy of Sleep Medicine systematic review, meta-analysis, and GRADE assessment. J Clin Sleep Med. 2021;17(9):1895-1945.
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Affiliation(s)
- Kiran Maski
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts
| | - Lynn Marie Trotti
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia
| | - Suresh Kotagal
- Department of Neurology, Mayo Clinic, Rochester, Minnesota
| | - R Robert Auger
- Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Todd J Swick
- Neuroscience's Clinical Division, Takeda Pharmaceuticals
| | - James A Rowley
- Department of Medicine, Wayne State University School of Medicine, Detroit, Michigan
| | | | - Nathaniel F Watson
- Department of Neurology, University of Washington School of Medicine, Seattle, Washington
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Racine E, Sattler S, Boehlen W. Cognitive Enhancement: Unanswered Questions About Human Psychology and Social Behavior. SCIENCE AND ENGINEERING ETHICS 2021; 27:19. [PMID: 33759032 PMCID: PMC7987623 DOI: 10.1007/s11948-021-00294-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 02/10/2021] [Indexed: 05/23/2023]
Abstract
Stimulant drugs, transcranial magnetic stimulation, brain-computer interfaces, and even genetic modifications are all discussed as forms of potential cognitive enhancement. Cognitive enhancement can be conceived as a benefit-seeking strategy used by healthy individuals to enhance cognitive abilities such as learning, memory, attention, or vigilance. This phenomenon is hotly debated in the public, professional, and scientific literature. Many of the statements favoring cognitive enhancement (e.g., related to greater productivity and autonomy) or opposing it (e.g., related to health-risks and social expectations) rely on claims about human welfare and human flourishing. But with real-world evidence from the social and psychological sciences often missing to support (or invalidate) these claims, the debate about cognitive enhancement is stalled. In this paper, we describe a set of crucial debated questions about psychological and social aspects of cognitive enhancement (e.g., intrinsic motivation, well-being) and explain why they are of fundamental importance to address in the cognitive enhancement debate and in future research. We propose studies targeting social and psychological outcomes associated with cognitive enhancers (e.g., stigmatization, burnout, mental well-being, work motivation). We also voice a call for scientific evidence, inclusive of but not limited to biological health outcomes, to thoroughly assess the impact of enhancement. This evidence is needed to engage in empirically informed policymaking, as well as to promote the mental and physical health of users and non-users of enhancement.
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Affiliation(s)
- Eric Racine
- Pragmatic Health Ethics Research Unit, Institut de recherches cliniques de Montréal (IRCM), 110, avenue des Pins Ouest, Montréal, QC, H2W 1R7, Canada.
- Department of Medicine and Department of Social and Preventive Medicine, Université de Montréal, 7101, Av du Parc, Montréal, QC, H3N 1X9, Canada.
- Departments of Neurology and Neurosurgery, Experimental Medicine, and Biomedical Ethics Unit, McGill University, 3801, University Street, Montréal, QC, H3A 1X1, Canada.
| | - Sebastian Sattler
- Pragmatic Health Ethics Research Unit, Institut de recherches cliniques de Montréal (IRCM), 110, avenue des Pins Ouest, Montréal, QC, H2W 1R7, Canada.
- Department of Sociology, University of Cologne, Universitätsstrasse 24, 50931, Cologne, Germany.
| | - Wren Boehlen
- Pragmatic Health Ethics Research Unit, Institut de recherches cliniques de Montréal (IRCM), 110, avenue des Pins Ouest, Montréal, QC, H2W 1R7, Canada
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Inoue Y, Tabata T, Tsukimori N. Efficacy and safety of modafinil in patients with idiopathic hypersomnia without long sleep time: a multicenter, randomized, double-blind, placebo-controlled, parallel-group comparison study. Sleep Med 2021; 80:315-321. [PMID: 33631500 DOI: 10.1016/j.sleep.2021.01.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 12/09/2020] [Accepted: 01/14/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Few treatments are available for patients with idiopathic hypersomnia (IH). Modafinil, an established treatment for narcolepsy, was tested for efficacy and safety in Japanese patients with IH without long sleep time. METHODS This multicenter, randomized, double-blind, placebo-controlled, parallel-group comparison study was conducted at 20 institutions in Japan. Patients who met the diagnostic criteria of IH in the International Classification of Sleep Disorders (second edition) were included. The study comprised a ≥17-day observation period and a 3-week treatment period during which modafinil (200 mg) or placebo was administered orally once daily (in the morning). The primary efficacy endpoint was change in mean sleep latency on the Maintenance of Wakefulness Test (MWT). Adverse events (AEs) were also recorded to evaluate safety. RESULTS In total, 123 patients were screened and 71 were randomized to receive modafinil (N = 34) or placebo (N = 37). Patients treated with modafinil experienced a significantly prolonged mean sleep latency on the MWT at the end of the study compared with placebo (5.02 min, 95% confidence interval: 3.26-6.77 min; p < 0.001). AEs occurred in 58.8% (20/34) and 27.0% (10/37) of patients in the modafinil and placebo groups, respectively. Frequent AEs in the modafinil group were headache (n = 6), dry mouth (n = 3), and nausea (n = 3); no clinically significant AEs occurred. CONCLUSION Modafinil was shown to be an effective and safe treatment for excessive daytime sleepiness in patients with IH without long sleep time. CLINICAL TRIAL REGISTRATION JapicCTI; 142539.
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Affiliation(s)
- Yuichi Inoue
- Japan Somnology Center, Institute of Neuropsychiatry, 5-10-10 Yoyogi, Shibuya-ku, Tokyo, 151-0053, Japan; Department of Somnology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.
| | - Toshiyuki Tabata
- Research and Development Headquarters, Alfresa Pharma Corporation, 2-2-9 Koku-machi, Chuo-ku, Osaka, 540-8575, Japan
| | - Naoji Tsukimori
- Medical Affairs Headquarters, Alfresa Pharma Corporation, 2-2-9 Koku-machi, Chuo-ku, Osaka, 540-8575, Japan
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Abstract
There are numerous disorders of known or presumed neurologic origin that result in excessive daytime sleepiness, collectively known as the central disorders of hypersomnolence. These include narcolepsy types 1 and 2, idiopathic hypersomnia, Kleine-Levin syndrome, and hypersomnia due to or associated with medical disease, neurologic disease, psychiatric disease, medications or substances, and insufficient sleep durations. This chapter focuses on the treatment of nonnarcoleptic hypersomnia syndromes, from those that are commonly encountered in neurologic practice, such as hypersomnia due to Parkinson's disease, to those that are exceedingly rare but present with dramatic manifestations, such as Kleine-Levin syndrome. The level of evidence for the treatment of sleepiness in these disorders is generally lower than in the well-characterized syndrome of narcolepsy, but available clinical and randomized, controlled trial data can provide guidance for the management of each of these disorders. Treatments vary by diagnosis but may include modafinil/armodafinil, traditional psychostimulants, solriamfetol, pitolisant, clarithromycin, flumazenil, sodium oxybate, melatonin, methylprednisolone, and lithium.
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Affiliation(s)
- Lynn Marie Trotti
- Department of Neurology, Emory University School of Medicine, and Emory Sleep Center, Emory Healthcare, 12 Executive Park Dr NE, Atlanta, GA, 30329, USA.
| | - Isabelle Arnulf
- Service des Pathologies du Sommeil, Centre National de Reference des Hypersomnies Rares, Hôpitaux Universitaires Pitié-Salpêtrière, Sorbonne Université, Paris, 75013, France
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Sousa A, Dinis-Oliveira RJ. Pharmacokinetic and pharmacodynamic of the cognitive enhancer modafinil: Relevant clinical and forensic aspects. Subst Abus 2020; 41:155-173. [PMID: 31951804 DOI: 10.1080/08897077.2019.1700584] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Modafinil is a nonamphetamine nootropic drug with an increasingly therapeutic interest due to its different sites of action and behavioral effects in comparison to cocaine or amphetamine. A review of modafinil (and of its prodrug adrafinil and its R-enantiomer armodafinil) chemical, pharmacokinetic, pharmacodynamic, toxicological, clinical and forensic aspects was performed, aiming to better understand possible health problems associated to its unconscious and unruled use. Modafinil is a racemate metabolized mainly in the liver into its inactive acid and sulfone metabolites, which undergo primarily renal excretion. Although not fully clarified, major effects seem to be associated to inhibition of dopamine reuptake and modulation of several other neurochemical pathways, namely noradrenergic, serotoninergic, orexinergic, histaminergic, glutamatergic and GABAergic. Due its wake-promoting effects, modafinil is used for the treatment of daily sleepiness associated to narcolepsy, obstructive sleep apnea and shift work sleep disorder. Its psychotropic and cognitive effects are also attractive in several other pathologies and conditions that affect sleep structure, induce fatigue and lethargy, and impair cognitive abilities. Additionally, in health subjects, including students, modafinil is being used off-label to overcome sleepiness, increase concentration and improve cognitive potential. The most common adverse effects associated to modafinil intake are headache, insomnia, anxiety, diarrhea, dry mouth and raise in blood pressure and heart rate. Infrequently, severe dermatologic effects in children, including maculopapular and morbilliform rash, erythema multiforme and Stevens-Johnson Syndrome have been reported. Intoxication and dependence associated to modafinil are uncommon. Further research on effects and health implications of modafinil and its analogs is steel needed to create evidence-based policies.
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Affiliation(s)
- Ana Sousa
- Department of Public Health and Forensic Sciences, and Medical Education, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Ricardo Jorge Dinis-Oliveira
- Department of Public Health and Forensic Sciences, and Medical Education, Faculty of Medicine, University of Porto, Porto, Portugal.,IINFACTS - Institute of Research and Advanced Training in Health Sciences and Technologies, Department of Sciences, University Institute of Health Sciences (IUCS), CESPU, CRL, Gandra, Portugal.,UCIBIO, REQUIMTE, Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, Porto, Portugal
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Update on the Treatment of Idiopathic Hypersomnia. CURRENT SLEEP MEDICINE REPORTS 2019. [DOI: 10.1007/s40675-019-00158-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Abstract
Purpose of Review
Idiopathic hypersomnia is an incapacitating disorder with a profound impact on daytime performance and quality of life. The most commonly used treatment modalities are lifestyle advice and pharmacological therapy. We present an update on the evidence concerning treatment options for idiopathic hypersomnia.
Recent Findings
Evidence for non-pharmacological interventions is lacking; improvement in symptoms on introducing these interventions is often less pronounced than in narcolepsy. Additional pharmacological treatment is therefore usually initiated. The few treatment studies that have been performed are hampered by small sample sizes and the use of variable and often insufficiently validated outcome parameters for the whole spectrum of idiopathic hypersomnia symptoms.
Conclusion
Evidence on treatment is scarce. Since the efficacy of modafinil is consistently described and there is much experience with this substance, it is reasonable to start with modafinil as a first choice treatment. Methylphenidate and dexamphetamine are good alternatives. In the future, newer drugs such as sodium oxybate, pitolisant, and solriamfetol might be authorized for use in idiopathic hypersomnia.
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12
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Arnulf I, Leu-Semenescu S, Dodet P. Precision Medicine for Idiopathic Hypersomnia. Sleep Med Clin 2019; 14:333-350. [DOI: 10.1016/j.jsmc.2019.05.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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13
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Barateau L, Lopez R, Dauvilliers Y. Clinical neurophysiology of CNS hypersomnias. HANDBOOK OF CLINICAL NEUROLOGY 2019; 161:353-367. [PMID: 31307613 DOI: 10.1016/b978-0-444-64142-7.00060-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Central nervous system hypersomnias (narcolepsy type 1 and type 2, idiopathic hypersomnia, and Kleine-Levin syndrome) are orphan sleep disorders in which the predominant symptom is excessive daytime sleepiness. The evaluation of sleepiness requires rigorous clinical and neurophysiologic approaches that may include the Epworth Sleepiness Scale, multiple sleep latency tests, and the maintenance of wakefulness test. However, to date, no gold standard measurement of excessive sleepiness exists, and there are no quantifiable biologic markers. The main pathophysiologic feature of central hypersomnias is thought to reflect a deficiency of arousal systems, rather than an overactivity of sleep systems or an imbalance between those systems. Impaired neurotransmission of hypocretin/orexin (neuropeptides of the lateral hypothalamus) is involved in the neurobiology of narcolepsy with cataplexy (NT1). NT1 is a well-characterized disorder, due to the destruction of hypocretin/orexin neurons by a probable autoimmune process. The biologic hallmarks of the other central hypersomnias remain unknown, and neurophysiologic biomarkers are still of major importance for the diagnosis and characterization of those disorders.
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Affiliation(s)
- Lucie Barateau
- Department of Neurology, Sleep-Wake Disorders Center, Hôpital Gui-de-Chauliac, Montpellier, France; National Reference Network for Narcolepsy, Montpellier, France
| | - Régis Lopez
- Department of Neurology, Sleep-Wake Disorders Center, Hôpital Gui-de-Chauliac, Montpellier, France; National Reference Network for Narcolepsy, Montpellier, France
| | - Yves Dauvilliers
- Department of Neurology, Sleep-Wake Disorders Center, Hôpital Gui-de-Chauliac, Montpellier, France; National Reference Network for Narcolepsy, Montpellier, France.
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Tzeng NS, Hsing SC, Chung CH, Chang HA, Kao YC, Mao WC, Yang CCH, Kuo TBJ, Chen TY, Chien WC. The Risk of Hospitalization for Motor Vehicle Accident Injury in Narcolepsy and the Benefits of Stimulant Use: A Nationwide Cohort Study in Taiwan. J Clin Sleep Med 2019; 15:881-889. [PMID: 31138389 DOI: 10.5664/jcsm.7842] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 02/21/2019] [Indexed: 12/20/2022]
Abstract
STUDY OBJECTIVES To examine the risk of hospitalization for motor vehicle accident injury (MVAI) in patients with narcolepsy and the effects of stimulant use on MVAI occurrence in patients with narcolepsy. METHODS This is a population-based, retrospective cohort study using Taiwan's National Health Insurance Research Database between 2000 and 2013. We included patients with narcolepsy based on the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes, 347. The case and matched control participants were selected in a ratio of 1:3, and the traffic accident (ICD-9-CM codes: E810-E819) plus injury codes (ICD-9-CM codes: 800.xx-999.xx) due to MVAI following hospitalization were used for the study outcome. The type of injury, causes, intentionality, and the effects of stimulant use on patients with narcolepsy were also assessed. RESULTS A total of 1,316 participants were enrolled, including 329 participants with narcolepsy and 987 participants without narcolepsy. During a 14-year follow-up period, a total of 104 participants had MVAI, of whom 47 (1,559.54 per 100,000 person-years) belonged to the narcolepsy cohort and 57 (556.21 per 100,000 person-years) to the non-narcolepsy cohort. After adjusting for covariates, the risk of hospitalization for MVAI among participants with narcolepsy was still significantly higher than those without narcolepsy (adjusted hazard ratio = 6.725; 95% confidence interval = 4.421-10.231; P < .001). The use of modafinil or methylphenidate, as monotherapy or combined treatment, was associated with a lower risk of MVAI in the narcolepsy cohort. CONCLUSIONS Patients with narcolepsy may have a higher risk of hospitalization for MVAI and stimulant use could mitigate such risk.
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Affiliation(s)
- Nian-Sheng Tzeng
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan.,Student Counseling Center, National Defense Medical Center, Taipei, Taiwan
| | - Shih-Chun Hsing
- Center for Healthcare Quality Management, Cheng Hsin General Hospital.,Department of Health Care Management, College of Health Technology, National Taipei University of Nursing and Heath Sciences
| | - Chi-Hsiang Chung
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.,School of Public Health, National Defense Medical Center, Taipei, Taiwan.,Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan
| | - Hsin-An Chang
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan.,Student Counseling Center, National Defense Medical Center, Taipei, Taiwan
| | - Yu-Chen Kao
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan.,Department of Psychiatry, Tri-Service General Hospital, Song-Shan Branch, National Defense Medical Center, Taipei, Taiwan
| | - Wei-Chung Mao
- Department of Psychiatry, Cheng Hsin General Hospital, Taipei, Taiwan.,School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Cheryl C H Yang
- Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan.,Sleep Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Terry B J Kuo
- Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan.,Sleep Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Tien-Yu Chen
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan.,Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan.,Sleep Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Wu-Chien Chien
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.,School of Public Health, National Defense Medical Center, Taipei, Taiwan.,Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan
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15
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Sagaspe P, Micoulaud-Franchi JA, Coste O, Léger D, Espié S, Davenne D, Lopez R, Dauvilliers Y, Philip P. Maintenance of Wakefulness Test, real and simulated driving in patients with narcolepsy/hypersomnia. Sleep Med 2019; 55:1-5. [DOI: 10.1016/j.sleep.2018.02.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 01/29/2018] [Accepted: 02/21/2018] [Indexed: 11/16/2022]
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16
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Ghergan A, Coupaye M, Leu-Semenescu S, Attali V, Oppert JM, Arnulf I, Poitou C, Redolfi S. Prevalence and Phenotype of Sleep Disorders in 60 Adults With Prader-Willi Syndrome. Sleep 2018; 40:4384753. [PMID: 29294134 DOI: 10.1093/sleep/zsx162] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Study Objectives Excessive sleepiness is a common symptom in Prader-Willi syndrome (PWS), and it negatively impacts the quality of life. Obstructive sleep apnea and narcolepsy phenotypes have been reported in PWS. We characterized sleep disorders in a large cohort of adults with PWS. Methods All consecutive patients with genetically confirmed PWS unselected for sleep-related symptoms, underwent a clinical interview, polysomnography, and multiple sleep latency tests (MSLT, n = 60), followed by long-term (24 hours) polysomnography (n = 22/60). Results Among 60 adults evaluated (57% female, aged 25 ± 10 years, body mass index: 39 ± 12 kg/m2), 67% reported excessive sleepiness. According to the sleep study results, 43% had a previously unrecognized hypersomnia disorder, 15% had an isolated sleep breathing disorder, 12% had combined hypersomnia disorder and untreated breathing sleep disorder, and only 30% had normal sleep. Isolated hypersomnia disorder included narcolepsy in 35% (type 1, n = 1, and type 2, n = 8), hypersomnia in 12% (total sleep time >11 hours, n = 2, and MSLT <8 minutes, n = 1), and borderline phenotype in 53% (≥2 sleep onset in REM periods and MSLT >8 minutes, n = 10, and 8 minutes < MSLT < 10 minutes, n = 4). Sleep breathing disorders, isolated and combined, included obstructive sleep apnea (n = 14, already treated in seven), sleep hypoxemia (n = 1) and previously undiagnosed hypoventilation (n = 5). Modafinil was taken by 16 patients (well tolerated in 10), resulting in improved sleepiness over a mean 5-year follow-up period. Conclusion Sleepiness affects more than half of adult patients with PWS, with a variety of hypersomnia disorder (narcolepsy, hypersomnia, and borderline phenotypes) and breathing sleep disorders. Earlier diagnosis and management of sleep disorders may improve sleepiness, cognition, and behavior in these patients.
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Affiliation(s)
- Adelina Ghergan
- Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pathologies du Sommeil (Département R3S) et Centre de Référence National pour Narcolepsie, Hypersomnie et Syndrome de Kleine-Levin, Paris, France
| | - Muriel Coupaye
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Nutrition, Centre de Référence National pour Syndrome de Prader-Willi et Institut Cardiométabolisme et Nutrition (ICAN), Paris, France
| | - Smaranda Leu-Semenescu
- Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pathologies du Sommeil (Département R3S) et Centre de Référence National pour Narcolepsie, Hypersomnie et Syndrome de Kleine-Levin, Paris, France
| | - Valérie Attali
- Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pathologies du Sommeil (Département R3S) et Centre de Référence National pour Narcolepsie, Hypersomnie et Syndrome de Kleine-Levin, Paris, France.,Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMRS1158 Neurophysiologie respiratoire expérimentale et clinique, Paris, France
| | - Jean-Michel Oppert
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Nutrition, Centre de Référence National pour Syndrome de Prader-Willi et Institut Cardiométabolisme et Nutrition (ICAN), Paris, France
| | - Isabelle Arnulf
- Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pathologies du Sommeil (Département R3S) et Centre de Référence National pour Narcolepsie, Hypersomnie et Syndrome de Kleine-Levin, Paris, France
| | - Christine Poitou
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Nutrition, Centre de Référence National pour Syndrome de Prader-Willi et Institut Cardiométabolisme et Nutrition (ICAN), Paris, France.,Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMRS1166 Nutriomique team 6, Paris, France
| | - Stefania Redolfi
- Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pathologies du Sommeil (Département R3S) et Centre de Référence National pour Narcolepsie, Hypersomnie et Syndrome de Kleine-Levin, Paris, France.,Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMRS1158 Neurophysiologie respiratoire expérimentale et clinique, Paris, France
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17
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Vodovar D, Duchêne A, Wimberley C, Leroy C, Pottier G, Dauvilliers Y, Giaume C, Lin JS, Mouthon F, Tournier N, Charvériat M. Cortico-Amygdala-Striatal Activation by Modafinil/Flecainide Combination. Int J Neuropsychopharmacol 2018; 21:687-696. [PMID: 29635319 PMCID: PMC6031015 DOI: 10.1093/ijnp/pyy027] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 02/21/2018] [Accepted: 03/14/2018] [Indexed: 02/07/2023] Open
Abstract
Background Modafinil, a nonamphetaminic wake-promoting compound, is prescribed as first line therapy in narcolepsy, an invalidating disorder characterized by excessive daytime sleepiness and cataplexy. Although its mode of action remains incompletely known, recent studies indicated that modafinil modulates astroglial connexin-based gap junctional communication as administration of a low dose of flecainide, an astroglial connexin inhibitor, enhanced the wake-promoting and procognitive activity of modafinil in rodents and healthy volunteers. The aim of this study is to investigate changes in glucose cerebral metabolism in rodents, induced by the combination of modafinil+flecainide low dose (called THN102). Methods The impact of THN102 on brain glucose metabolism was noninvasively investigated using 18F-2-fluoro-2-deoxy-D-glucose Positron Emission Tomography imaging in Sprague-Dawley male rats. Animals were injected with vehicle, flecainide, modafinil, or THN102 and further injected with 18F-2-fluoro-2-deoxy-D-glucose followed by 60-minute Positron Emission Tomography acquisition. 18F-2-fluoro-2-deoxy-D-glucose Positron Emission Tomography images were coregistered to a rat brain template and normalized from the total brain Positron Emission Tomography signal. Voxel-to-voxel analysis was performed using SPM8 software. Comparison of brain glucose metabolism between groups was then performed. Results THN102 significantly increased regional brain glucose metabolism as it resulted in large clusters of 18F-2-fluoro-2-deoxy-D-glucose uptake localized in the cortex, striatum, and amygdala compared with control or drugs administered alone. These regions, highly involved in the regulation of sleep-wake cycle, emotions, and cognitive functions were hence quantitatively modulated by THN102. Conclusion Data presented here provide the first evidence of a regional brain activation induced by THN102, currently being tested in a phase II clinical trial in narcoleptic patients.
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Affiliation(s)
- Dominique Vodovar
- Imagerie Moléculaire In Vivo, IMIV, CEA, Inserm, CNRS, Univ. Paris-Sud, Univ. Paris Saclay, CEA-SHFJ, Orsay, France
| | | | - Catriona Wimberley
- Imagerie Moléculaire In Vivo, IMIV, CEA, Inserm, CNRS, Univ. Paris-Sud, Univ. Paris Saclay, CEA-SHFJ, Orsay, France
| | - Claire Leroy
- Imagerie Moléculaire In Vivo, IMIV, CEA, Inserm, CNRS, Univ. Paris-Sud, Univ. Paris Saclay, CEA-SHFJ, Orsay, France
| | - Géraldine Pottier
- Imagerie Moléculaire In Vivo, IMIV, CEA, Inserm, CNRS, Univ. Paris-Sud, Univ. Paris Saclay, CEA-SHFJ, Orsay, France
| | - Yves Dauvilliers
- National Reference Centre for Narcolepsy, CHU Montpellier, INSERM, France
| | - Christian Giaume
- Collège de France, Centre for Interdisciplinary Research in Biology, Paris, France
| | - Jian-Sheng Lin
- Laboratory WAKING, CRNL-INSERM U1028-CNRS UMR 5292-UCBL, Lyon, France
| | | | - Nicolas Tournier
- Imagerie Moléculaire In Vivo, IMIV, CEA, Inserm, CNRS, Univ. Paris-Sud, Univ. Paris Saclay, CEA-SHFJ, Orsay, France
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Abstract
PURPOSE OF REVIEW This article focuses on the clinical presentation, pathophysiology, diagnosis, differential diagnosis, and management of narcolepsy type 1 and narcolepsy type 2, idiopathic hypersomnia, Kleine-Levin syndrome, and other central disorders of hypersomnolence, as defined in the International Classification of Sleep Disorders, Third Edition (ICSD-3). RECENT FINDINGS In ICSD-3, the names of some central disorders of hypersomnolence have been changed: narcolepsy with cataplexy and narcolepsy without cataplexy have been renamed narcolepsy type 1 and narcolepsy type 2, respectively. A low level of hypocretin-1/orexin-A in the CSF is now theoretically sufficient to diagnose narcolepsy type 1, as it is a highly specific and sensitive biomarker. Conversely, other central hypersomnias are less well-defined disorders with variability in the phenotype, and few reliable biomarkers have been discovered so far. The epidemiologic observation that influenza A (H1N1) infection and vaccination are potential triggering factors of narcolepsy type 1 (discovered during the 2009 H1N1 pandemic) has increased interest in this rare disease, and progress is being made to better understand the process (highly suspected to be autoimmune) responsible for the destruction of hypocretin neurons. Treatment of narcolepsy remains largely symptomatic, usually initially with modafinil or armodafinil or with higher-potency stimulants such as methylphenidate or amphetamines. Several newer wake-promoting agents and psychostimulants have also been developed, including sodium oxybate, which has a role in the treatment of cataplexy and as an adjunctive wake-promoting agent, and pitolisant, a selective histamine H3 receptor inverse agonist that is currently only available in Europe. SUMMARY Although far less common than many other sleep disorders, central hypersomnias are among the most severe and disabling diseases in the field of sleep medicine, and their early recognition is of major importance for patients, especially children, to maximize their quality of life and functioning in activities of daily living.
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19
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Ruoff C, Pizza F, Trotti LM, Sonka K, Vandi S, Cheung J, Pinto S, Einen M, Simakajornboon N, Han F, Peppard P, Nevsimalova S, Plazzi G, Rye D, Mignot E. The MSLT is Repeatable in Narcolepsy Type 1 But Not Narcolepsy Type 2: A Retrospective Patient Study. J Clin Sleep Med 2018; 14:65-74. [PMID: 29198301 DOI: 10.5664/jcsm.6882] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 10/03/2017] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES To examine repeatability of Multiple Sleep Latency Test (MSLT) results in narcolepsy type 1 (NT1) and narcolepsy type 2 (NT2) according to the criteria of the International Classification of Sleep Disorders, Third Edition (ICSD-3). METHODS Repeatability of the MSLT was retrospectively evaluated in NT1 (n = 60) and NT2 (n = 54) cases, and controls (n = 15). All subjects had documented HLA-DQB1*06:02 status and/or hypocretin-1 levels from cerebrospinal fluid. All subjects had undergone 2 MSLTs (≥ 1 meeting ICSD-3 criteria for narcolepsy). Repeatability was explored in children versus adults and in those on versus not on medication(s). Subsample and multivariate analysis were performed. RESULTS Both MSLTs in unmedicated patients were positive for narcolepsy in 78%, 18%, and 7% of NT1, NT2, and controls, respectively. NT2 cases changed to idiopathic hypersomnia or to a negative MSLT 26% and 57% of the time, respectively. Although NT1 cases were 10 to 14 times more likely to demonstrate a second positive MSLT compared to NT2 cases (P < 10-5) and controls (P < 10-4), respectively, NT2 cases were not significantly different from controls (P = .64). Medication use (P = .009) but not adult versus children status (P = .85) significantly decreased the likelihood of a repeat positive MSLT. CONCLUSIONS In a clinical setting, a positive MSLT for narcolepsy is a more reproducible and stable feature in NT1 than NT2. The retrospective design of this study hinders interpretation of these data, as there are many different, and possibly opposing, reasons to repeat a MSLT in NT1 versus NT2 (ie, ascertainment bias). Additional systematic MSLT repeatability studies independent of confounds are ideally needed to confirm these findings.
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Affiliation(s)
- Chad Ruoff
- Center for Sleep Sciences and Medicine, Department of Psychiatry and Behavioral Sciences, Stanford University, School of Medicine, Palo Alto, California
| | - Fabio Pizza
- IRCCS Istituto delle Scienze Neurologiche, ASL di Bologna, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Lynn Marie Trotti
- Department of Neurology, Emory Sleep Center, Emory University School of Medicine, Atlanta, Georgia
| | - Karel Sonka
- Department of Neurology, 1st Medical Faculty, Charles University, Prague, Czeck Republic
| | - Stefano Vandi
- IRCCS Istituto delle Scienze Neurologiche, ASL di Bologna, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Joseph Cheung
- Center for Sleep Sciences and Medicine, Department of Psychiatry and Behavioral Sciences, Stanford University, School of Medicine, Palo Alto, California
| | - Swaroop Pinto
- Sleep Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Division of Pulmonology and Sleep Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Mali Einen
- Center for Sleep Sciences and Medicine, Department of Psychiatry and Behavioral Sciences, Stanford University, School of Medicine, Palo Alto, California
| | - Narong Simakajornboon
- Sleep Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Division of Pulmonology and Sleep Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Fang Han
- Department of Pulmonary Medicine, Peking University People's Hospital, Beijing, China
| | - Paul Peppard
- Department of Preventive Medicine, University of Madison Wisconsin, Madison, Wisconsin
| | - Sona Nevsimalova
- Department of Neurology, 1st Medical Faculty, Charles University, Prague, Czeck Republic
| | - Giuseppe Plazzi
- IRCCS Istituto delle Scienze Neurologiche, ASL di Bologna, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - David Rye
- Department of Neurology, Emory Sleep Center, Emory University School of Medicine, Atlanta, Georgia
| | - Emmanuel Mignot
- Center for Sleep Sciences and Medicine, Department of Psychiatry and Behavioral Sciences, Stanford University, School of Medicine, Palo Alto, California
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20
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Evangelista E, Lopez R, Dauvilliers Y. Update on treatment for idiopathic hypersomnia. Expert Opin Investig Drugs 2018; 27:187-192. [DOI: 10.1080/13543784.2018.1417385] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Elisa Evangelista
- Centre National de Référence Narcolepsie Hypersomnies, Unité des Troubles du Sommeil, Service de Neurologie, Hôpital Gui-de-Chauliac Montpellier, Montpellier, France
- Inserm U1061, Montpellier, France
| | - Régis Lopez
- Centre National de Référence Narcolepsie Hypersomnies, Unité des Troubles du Sommeil, Service de Neurologie, Hôpital Gui-de-Chauliac Montpellier, Montpellier, France
- Inserm U1061, Montpellier, France
- Université de Montpellier, Montpellier, France
| | - Yves Dauvilliers
- Centre National de Référence Narcolepsie Hypersomnies, Unité des Troubles du Sommeil, Service de Neurologie, Hôpital Gui-de-Chauliac Montpellier, Montpellier, France
- Inserm U1061, Montpellier, France
- Université de Montpellier, Montpellier, France
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21
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Abstract
Idiopathic hypersomnia (IH) is a chronic neurologic disorder of daytime sleepiness, accompanied by long sleep times, unrefreshing sleep, difficulty in awakening, cognitive dysfunction, and autonomic symptoms. The cause is unknown; a genetic predisposition is suggested. Autonomic, inflammatory, or immune dysfunction has been proposed. Diagnosis involves a clinical history and objective testing. There are no approved treatments for IH, but modafinil is typically considered first-line. A substantial fraction of patients with IH are refractory or intolerant to standard treatments, and different treatment strategies using novel therapeutics are necessary. Even with current treatment options, quality of life and safety may remain impaired.
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Affiliation(s)
- Lynn Marie Trotti
- Department of Neurology, Emory Sleep Center, Emory University School of Medicine, 12 Executive Park Drive Northeast, Atlanta, GA 30329, USA.
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22
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23
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Lopez R, Arnulf I, Drouot X, Lecendreux M, Dauvilliers Y. French consensus. Management of patients with hypersomnia: Which strategy? Rev Neurol (Paris) 2017; 173:8-18. [DOI: 10.1016/j.neurol.2016.09.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 09/20/2016] [Indexed: 10/20/2022]
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24
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Idiopathic hypersomnia. Sleep Med Rev 2016; 29:23-33. [DOI: 10.1016/j.smrv.2015.08.007] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 08/24/2015] [Accepted: 08/24/2015] [Indexed: 11/18/2022]
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25
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Sowa NA. Idiopathic Hypersomnia and Hypersomnolence Disorder: A Systematic Review of the Literature. PSYCHOSOMATICS 2016; 57:152-64. [DOI: 10.1016/j.psym.2015.12.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 12/10/2015] [Accepted: 12/11/2015] [Indexed: 01/26/2023]
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26
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Benefits and risk of sodium oxybate in idiopathic hypersomnia versus narcolepsy type 1: a chart review. Sleep Med 2016; 17:38-44. [DOI: 10.1016/j.sleep.2015.10.005] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 10/11/2015] [Accepted: 10/12/2015] [Indexed: 11/22/2022]
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27
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Khan Z, Trotti LM. Central Disorders of Hypersomnolence: Focus on the Narcolepsies and Idiopathic Hypersomnia. Chest 2015; 148:262-273. [PMID: 26149554 DOI: 10.1378/chest.14-1304] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
The central disorders of hypersomnolence are characterized by severe daytime sleepiness, which is present despite normal quality and timing of nocturnal sleep. Recent reclassification distinguishes three main subtypes: narcolepsy type 1, narcolepsy type 2, and idiopathic hypersomnia (IH), which are the focus of this review. Narcolepsy type 1 results from loss of hypothalamic hypocretin neurons, while the pathophysiology underlying narcolepsy type 2 and IH remains to be fully elucidated. Treatment of all three disorders focuses on the management of sleepiness, with additional treatment of cataplexy in those patients with narcolepsy type 1. Sleepiness can be treated with modafinil/armodafinil or sympathomimetic CNS stimulants, which have been shown to be beneficial in randomized controlled trials of narcolepsy and, quite recently, IH. In those patients with narcolepsy type 1, sodium oxybate is effective for the treatment of both sleepiness and cataplexy. Despite these treatments, there remains a subset of hypersomnolent patients with persistent sleepiness, in whom alternate therapies are needed. Emerging treatments for sleepiness include histamine H3 antagonists (eg, pitolisant) and possibly negative allosteric modulators of the gamma-aminobutyric acid-A receptor (eg, clarithromycin and flumazenil).
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Affiliation(s)
- Zeeshan Khan
- Emory Sleep Center, Emory University School of Medicine, Atlanta, GA
| | - Lynn Marie Trotti
- Emory Sleep Center, Emory University School of Medicine, Atlanta, GA.
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28
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Fernández A, Mascayano F, Lips W, Painel A, Norambuena J, Madrid E. Effects of modafinil on attention performance, short-term memory and executive function in university students: a randomized trial. Medwave 2015; 15:e6166. [DOI: 10.5867/medwave.2015.05.6166] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 06/05/2015] [Indexed: 11/27/2022] Open
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Affiliation(s)
- Gulnur Com
- University of Arkansas Medical Sciences, Little Rock, AR, USA
| | - Mali A Einen
- Stanford University Center for Narcolepsy, Redwood City, CA, USA
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30
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Mayer G, Benes H, Young P, Bitterlich M, Rodenbeck A. Modafinil in the treatment of idiopathic hypersomnia without long sleep time-a randomized, double-blind, placebo-controlled study. J Sleep Res 2014; 24:74-81. [DOI: 10.1111/jsr.12201] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Accepted: 06/18/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Geert Mayer
- Hephata Klinik; Schwalmstadt-Treysa Germany
- Department of Neurology; Philipps-Universität Marburg; Marburg Germany
| | - Heike Benes
- Department of Neurology; University of Rostock; Rostock Germany
| | - Peter Young
- Department for Sleep Medicine and Neuromuscular Disorders; University of Münster; Münster Germany
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31
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Trotti LM, Saini P, Freeman AA, Bliwise DL, García PS, Jenkins A, Rye DB. Improvement in daytime sleepiness with clarithromycin in patients with GABA-related hypersomnia: Clinical experience. J Psychopharmacol 2014; 28:697-702. [PMID: 24306133 DOI: 10.1177/0269881113515062] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The macrolide antibiotic clarithromycin can enhance central nervous system excitability, possibly by antagonism of GABA-A receptors. Enhancement of GABA signaling has recently been demonstrated in a significant proportion of patients with central nervous system hypersomnias, so we sought to determine whether clarithromycin might provide symptomatic benefit in these patients. We performed a retrospective review of all patients treated with clarithromycin for hypersomnia, in whom cerebrospinal fluid enhanced GABA-A receptor activity in vitro in excess of controls, excluding those with hypocretin deficiency or definite cataplexy. Subjective reports of benefit and objective measures of psychomotor vigilance were collected to assess clarithromycin's effects. Clinical and demographic characteristics were compared in responders and non-responders. In total, 53 patients (38 women, mean age 35.2 (SD 12.8 years)) were prescribed clarithromycin. Of these, 34 (64%) reported improvement in daytime sleepiness, while 10 (19%) did not tolerate its side effects, and nine (17%) found it tolerable but without symptomatic benefit. In those who reported subjective benefit, objective corroboration of improved vigilance was evident on the psychomotor vigilance task. Twenty patients (38%) elected to continue clarithromycin therapy. Clarithromycin responders were significantly younger than non-responders. Clarithromycin may be useful in the treatment of hypersomnia associated with enhancement of GABA-A receptor function. Further evaluation of this novel therapy is needed.
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Affiliation(s)
- Lynn Marie Trotti
- Department of Neurology and Emory Program in Sleep, Emory University School of Medicine, Atlanta, GA, USA
| | - Prabhjyot Saini
- Department of Neurology and Emory Program in Sleep, Emory University School of Medicine, Atlanta, GA, USA
| | - Amanda A Freeman
- Department of Neurology and Emory Program in Sleep, Emory University School of Medicine, Atlanta, GA, USA
| | - Donald L Bliwise
- Department of Neurology and Emory Program in Sleep, Emory University School of Medicine, Atlanta, GA, USA
| | - Paul S García
- Department of Anesthesia, Emory University School of Medicine, Atlanta, GA, USA Atlanta VA Medical Center, Atlanta, GA, USA
| | - Andrew Jenkins
- Department of Anesthesia, Emory University School of Medicine, Atlanta, GA, USA
| | - David B Rye
- Department of Neurology and Emory Program in Sleep, Emory University School of Medicine, Atlanta, GA, USA
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32
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Leu-Semenescu S, Nittur N, Golmard JL, Arnulf I. Effects of pitolisant, a histamine H3 inverse agonist, in drug-resistant idiopathic and symptomatic hypersomnia: a chart review. Sleep Med 2014; 15:681-7. [DOI: 10.1016/j.sleep.2014.01.021] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Revised: 12/10/2013] [Accepted: 01/07/2014] [Indexed: 10/25/2022]
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Baumann CR, Mignot E, Lammers GJ, Overeem S, Arnulf I, Rye D, Dauvilliers Y, Honda M, Owens JA, Plazzi G, Scammell TE. Challenges in diagnosing narcolepsy without cataplexy: a consensus statement. Sleep 2014; 37:1035-42. [PMID: 24882898 DOI: 10.5665/sleep.3756] [Citation(s) in RCA: 106] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Diagnosing narcolepsy without cataplexy is often a challenge as the symptoms are nonspecific, current diagnostic tests are limited, and there are no useful biomarkers. In this report, we review the clinical and physiological aspects of narcolepsy without cataplexy, the limitations of available diagnostic procedures, and the differential diagnoses, and we propose an approach for more accurate diagnosis of narcolepsy without cataplexy. METHODS A group of clinician-scientists experienced in narcolepsy reviewed the literature and convened to discuss current diagnostic tools, and to map out directions for research that should lead to a better understanding and more accurate diagnosis of narcolepsy without cataplexy. RECOMMENDATIONS To aid in the identification of narcolepsy without cataplexy, we review key indicators of narcolepsy and present a diagnostic algorithm. A detailed clinical history is mainly helpful to rule out other possible causes of chronic sleepiness. The multiple sleep latency test remains the most important measure, and prior sleep deprivation, shift work, or circadian disorders should be excluded by actigraphy or sleep logs. A short REM sleep latency (≤ 15 minutes) on polysomnography can aid in the diagnosis of narcolepsy without cataplexy, although sensitivity is low. Finally, measurement of hypocretin levels can helpful, as levels are low to intermediate in 10% to 30% of narcolepsy without cataplexy patients.
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Affiliation(s)
- Christian R Baumann
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland ; Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Emmanuel Mignot
- Stanford Center for Sleep Sciences, Stanford University, Stanford, CA
| | - Gert Jan Lammers
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Sebastiaan Overeem
- Department of Neurology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Isabelle Arnulf
- Hôpital Pitié-Salpêtrière, Pierre and Marie Curie University, Paris, France
| | - David Rye
- Department of Neurology and Program in Sleep, Emory University School of Medicine, Atlanta
| | - Yves Dauvilliers
- National Reference Network for Orphan Diseases (Narcolepsy), Department of Neurology, Hôpital Gui de Chauliac, CHU Montpellier, INSERM U1061, France
| | - Makoto Honda
- Tokyo Metropolitan Institute of Sleep Science, Tokyo, Japan
| | - Judith A Owens
- Sleep Medicine Children's National Med Center, Washington, DC
| | - Giuseppe Plazzi
- Department of Biomedical and Neuromotor Neurological Sciences, University of Bologna, and IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy
| | - Thomas E Scammell
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
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Trotti LM, Staab BA, Rye DB. Test-retest reliability of the multiple sleep latency test in narcolepsy without cataplexy and idiopathic hypersomnia. J Clin Sleep Med 2013; 9:789-95. [PMID: 23946709 DOI: 10.5664/jcsm.2922] [Citation(s) in RCA: 128] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Differentiation of narcolepsy without cataplexy from idiopathic hypersomnia relies entirely upon the multiple sleep latency test (MSLT). However, the test-retest reliability for these central nervous system hypersomnias has never been determined. METHODS Patients with narcolepsy without cataplexy, idiopathic hypersomnia, and physiologic hypersomnia who underwent two diagnostic multiple sleep latency tests were identified retrospectively. Correlations between the mean sleep latencies on the two studies were evaluated, and we probed for demographic and clinical features associated with reproducibility versus change in diagnosis. RESULTS Thirty-six patients (58% women, mean age 34 years) were included. Inter -test interval was 4.2 ± 3.8 years (range 2.5 months to 16.9 years). Mean sleep latencies on the first and second tests were 5.5 (± 3.7 SD) and 7.3 (± 3.9) minutes, respectively, with no significant correlation (r = 0.17, p = 0.31). A change in diagnosis occurred in 53% of patients, and was accounted for by a difference in the mean sleep latency (N = 15, 42%) or the number of sleep onset REM periods (N = 11, 31%). The only feature predictive of a diagnosis change was a history of hypnagogic or hypnopompic hallucinations. CONCLUSIONS The multiple sleep latency test demonstrates poor test-retest reliability in a clinical population of patients with central nervous system hypersomnia evaluated in a tertiary referral center. Alternative diagnostic tools are needed.
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Affiliation(s)
- Lynn Marie Trotti
- Program in Sleep, Department of Neurology, Emory University School of Medicine, Atlanta, GA 30329, USA.
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Rye DB, Bliwise DL, Parker K, Trotti LM, Saini P, Fairley J, Freeman A, Garcia PS, Owens MJ, Ritchie JC, Jenkins A. Modulation of vigilance in the primary hypersomnias by endogenous enhancement of GABAA receptors. Sci Transl Med 2013; 4:161ra151. [PMID: 23175709 DOI: 10.1126/scitranslmed.3004685] [Citation(s) in RCA: 106] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The biology underlying excessive daytime sleepiness (hypersomnolence) is incompletely understood. After excluding known causes of sleepiness in 32 hypersomnolent patients, we showed that, in the presence of 10 μM γ-aminobutyric acid (GABA), cerebrospinal fluid (CSF) from these subjects stimulated GABA(A) receptor function in vitro by 84.0 ± 40.7% (SD) relative to the 35.8 ± 7.5% (SD) stimulation obtained with CSF from control subjects (Student's t test, t = 6.47, P < 0.0001); CSF alone had no effect on GABA(A) signaling. The bioactive CSF component had a mass of 500 to 3000 daltons and was neutralized by trypsin. Enhancement was greater for α2 subunit- versus α1 subunit-containing GABA(A) receptors and negligible for α4 subunit-containing ones. CSF samples from hypersomnolent patients also modestly enhanced benzodiazepine (BZD)-insensitive GABA(A) receptors and did not competitively displace BZDs from human brain tissue. Flumazenil--a drug that is generally believed to antagonize the sedative-hypnotic actions of BZDs only at the classical BZD-binding domain in GABA(A) receptors and to lack intrinsic activity--nevertheless reversed enhancement of GABA(A) signaling by hypersomnolent CSF in vitro. Furthermore, flumazenil normalized vigilance in seven hypersomnolent patients. We conclude that a naturally occurring substance in CSF augments inhibitory GABA signaling, thus revealing a new pathophysiology associated with excessive daytime sleepiness.
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Affiliation(s)
- David B Rye
- Department of Neurology, Program in Sleep, Emory University School of Medicine, Atlanta, GA 30322, USA.
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Inocente CO, Lavault S, Lecendreux M, Dauvilliers Y, Reimao R, Gustin MP, Castets S, Spiegel K, Lin JS, Arnulf I, Franco P. Impact of obesity in children with narcolepsy. CNS Neurosci Ther 2013; 19:521-8. [PMID: 23574649 DOI: 10.1111/cns.12105] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Revised: 02/25/2013] [Accepted: 02/26/2013] [Indexed: 12/20/2022] Open
Abstract
AIMS To evaluate the impact of obesity on clinical and sleep characteristics in a population of narcoleptic children. METHODS Data from the children diagnosed with idiopathic narcolepsy in the National Reference Centers for Narcolepsy were collected between 2008 and 2011. Clinical and electrophysiological characteristics were compared between obese (body mass index [BMI] greater than P97) and nonobese children. RESULTS The 117 children (65 boys, 59 de novo patients) had a mean age of 11.6 ± 3.1 years on diagnosis. Cataplexy was present in 81%, DQB1*0602 in 91%. Mean BMI was 23.2 ± 5.2 kg/m(2) and BMI z-score was 2.9 ± 2.6. Obesity was found in 60% with a similar prevalence in treated versus de novo patients and in patients with and without cataplexy. Sleepiness and cataplexy started earlier in obese children. Obese narcoleptic children had lower sleep efficiency, higher apnea hypopnea index and respiratory arousals index (RAI) than nonobese children. BMI z-score was positively correlated with RAI. Obese children were more tired and missed more often school than nonobese children. CONCLUSION Obesity affects more than 50% of narcoleptic children, mostly younger at disease onset, and has a deleterious impact on sleep quality as well as on school attendance.
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Affiliation(s)
- Clara Odilia Inocente
- Integrative Physiology of Brain Arousal System, CRNL, University Lyon 1, Lyon, France
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Vecchierini MF, Léger D, Arnufl I, Dauvilliers Y. Quel apport des centres de référence maladies rares dans la prise en charge des hypersomnies rares ? Rev Neurol (Paris) 2013; 169 Suppl 1:S56-62. [DOI: 10.1016/s0035-3787(13)70061-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Nittur N, Konofal E, Dauvilliers Y, Franco P, Leu-Semenescu S, Cock VCD, Inocente CO, Bayard S, Scholtz S, Lecendreux M, Arnulf I. Mazindol in narcolepsy and idiopathic and symptomatic hypersomnia refractory to stimulants: A long-term chart review. Sleep Med 2013; 14:30-6. [DOI: 10.1016/j.sleep.2012.07.008] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Revised: 07/27/2012] [Accepted: 07/30/2012] [Indexed: 11/30/2022]
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Pizza F, Ferri R, Poli F, Vandi S, Cosentino FII, Plazzi G. Polysomnographic study of nocturnal sleep in idiopathic hypersomnia without long sleep time. J Sleep Res 2012; 22:185-96. [DOI: 10.1111/j.1365-2869.2012.01061.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2011] [Accepted: 09/12/2012] [Indexed: 11/28/2022]
Affiliation(s)
- Fabio Pizza
- Department of Neurological Sciences; University of Bologna/IRCCS Istituto delle Scienze Neurologiche; Bologna; Italy
| | - Raffaele Ferri
- Department of Neurology; Oasi Institute IRCCS; Troina; Italy
| | - Francesca Poli
- Department of Neurological Sciences; University of Bologna/IRCCS Istituto delle Scienze Neurologiche; Bologna; Italy
| | - Stefano Vandi
- Department of Neurological Sciences; University of Bologna/IRCCS Istituto delle Scienze Neurologiche; Bologna; Italy
| | | | - Giuseppe Plazzi
- Department of Neurological Sciences; University of Bologna/IRCCS Istituto delle Scienze Neurologiche; Bologna; Italy
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Abstract
Central hypersomnias are diseases manifested in excessive daytime sleepiness (EDS) not caused by disturbed nocturnal sleep or misaligned circadian rhythms. Central hypersomnias includes narcolepsy with and without cataplexy, recurrent hypersomnia, idiopathic hypersomnia, with and without long sleep time, behaviorally induced insufficient sleep syndrome, hypersomnia and narcolepsy due to medical conditions, and finally hypersomnia induced by substance intake. The Epworth Sleepiness Scale is a subjective tool mostly used for EDS assessment, while the Multiple Sleep Latency Test serves as an objective diagnostic method for narcolepsy and idiopathic hypersomnias. As for symptomatic therapy of EDS, the central nervous system stimulants modafinil and methylphenidate seem to work well in most cases and in narcolepsy and Parkinson's disease; sodium oxybate also has notable therapeutic value.
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Affiliation(s)
- Karel Sonka
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Katerinska 30, Prague, Czech Republic
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Hilton-Jones D, Bowler M, Lochmueller H, Longman C, Petty R, Roberts M, Rogers M, Turner C, Wilcox D. Modafinil for excessive daytime sleepiness in myotonic dystrophy type 1--the patients' perspective. Neuromuscul Disord 2012; 22:597-603. [PMID: 22425060 DOI: 10.1016/j.nmd.2012.02.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2011] [Revised: 02/05/2012] [Accepted: 02/07/2012] [Indexed: 01/19/2023]
Abstract
Excessive daytime sleepiness (EDS), of very similar pattern to that seen in narcolepsy syndrome, is extremely common in myotonic dystrophy type 1 (DM1). In a significant minority it has a profound disabling effect on employment, social functioning and activities of daily living. Limited published studies have shown inconsistent results from use of the psychostimulant drug modafinil. A recent European Medicines Agency (EMA) review concluded that on current evidence regarding safety and efficacy, modafinil's use should be restricted to the treatment of narcolepsy. In other conditions (although DM1 was not specifically considered) it was concluded that there was insufficient evidence of benefit to outweigh potentially serious side-effects, including severe skin reactions and cardiac arrhythmia. Clinicians with extensive experience in the management of DM1 have found modafinil to be extremely effective in appropriately selected patients with a very low incidence of serious side-effects. Given the recent EMA review, patients have expressed concern about the potential restriction of the use of modafinil in DM1. This brief review is an audit of the experience of a large group of patients and their clinicians concerning EDS and DM1 and concludes that despite the limited literature there is strong evidence to support the use of modafinil in carefully selected patients.
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Affiliation(s)
- D Hilton-Jones
- Department of Neurology, West Wing, John Radcliffe Hospital, Oxford OX3 9DU, UK.
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Pecotic R, Dodig IP, Valic M, Ivkovic N, Dogas Z. The evaluation of the Croatian version of the Epworth sleepiness scale and STOP questionnaire as screening tools for obstructive sleep apnea syndrome. Sleep Breath 2011; 16:793-802. [DOI: 10.1007/s11325-011-0578-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2011] [Revised: 07/26/2011] [Accepted: 08/15/2011] [Indexed: 02/01/2023]
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