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Biscarini F, Barateau L, Pizza F, Plazzi G, Dauvilliers Y. Narcolepsy and rapid eye movement sleep. J Sleep Res 2024:e14277. [PMID: 38955433 DOI: 10.1111/jsr.14277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 06/06/2024] [Accepted: 06/09/2024] [Indexed: 07/04/2024]
Abstract
Since the first description of narcolepsy at the end of the 19th Century, great progress has been made. The disease is nowadays distinguished as narcolepsy type 1 and type 2. In the 1960s, the discovery of rapid eye movement sleep at sleep onset led to improved understanding of core sleep-related disease symptoms of the disease (excessive daytime sleepiness with early occurrence of rapid eye movement sleep, sleep-related hallucinations, sleep paralysis, rapid eye movement parasomnia), as possible dysregulation of rapid eye movement sleep, and cataplexy resembling an intrusion of rapid eye movement atonia during wake. The relevance of non-sleep-related symptoms, such as obesity, precocious puberty, psychiatric and cardiovascular morbidities, has subsequently been recognized. The diagnostic tools have been improved, but sleep-onset rapid eye movement periods on polysomnography and Multiple Sleep Latency Test remain key criteria. The pathogenic mechanisms of narcolepsy type 1 have been partly elucidated after the discovery of strong HLA class II association and orexin/hypocretin deficiency, a neurotransmitter that is involved in altered rapid eye movement sleep regulation. Conversely, the causes of narcolepsy type 2, where cataplexy and orexin deficiency are absent, remain unknown. Symptomatic medications to treat patients with narcolepsy have been developed, and management has been codified with guidelines, until the recent promising orexin-receptor agonists. The present review retraces the steps of the research on narcolepsy that linked the features of the disease with rapid eye movement sleep abnormality, and those that do not appear associated with rapid eye movement sleep.
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Affiliation(s)
- Francesco Biscarini
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Lucie Barateau
- Sleep-Wake Disorders Unit, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier, Montpellier, France
- National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic Hypersomnia, and Kleine-Levin Syndrome, Montpellier, France
- Institute for Neurosciences of Montpellier, University of Montpellier, INSERM, Montpellier, France
| | - Fabio Pizza
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Giuseppe Plazzi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio-Emilia, Modena, Italy
| | - Yves Dauvilliers
- Sleep-Wake Disorders Unit, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier, Montpellier, France
- National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic Hypersomnia, and Kleine-Levin Syndrome, Montpellier, France
- Institute for Neurosciences of Montpellier, University of Montpellier, INSERM, Montpellier, France
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2
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Koyama Y. The role of orexinergic system in the regulation of cataplexy. Peptides 2023; 169:171080. [PMID: 37598758 DOI: 10.1016/j.peptides.2023.171080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 08/06/2023] [Accepted: 08/18/2023] [Indexed: 08/22/2023]
Abstract
Loss of orexin/hypocretin causes serious sleep disorder; narcolepsy. Cataplexy is the most striking symptom of narcolepsy, characterized by abrupt muscle paralysis induced by emotional stimuli, and has been considered pathological activation of REM sleep atonia system. Clinical treatments for cataplexy/narcolepsy and early pharmacological studies in narcoleptic dogs tell us about the involvement of monoaminergic and cholinergic systems in the control of cataplexy/narcolepsy. Muscle atonia may be induced by activation of REM sleep-atonia generating system in the brainstem. Emotional stimuli may be processed in the limbic systems including the amygdala, nucleus accumbens, and medial prefrontal cortex. It is now considered that orexin/hypocretin prevents cataplexy by modulating the activity of different points of cataplexy-inducing circuit, including monoaminergic/cholinergic systems, muscle atonia-generating systems, and emotion-related systems. This review will describe the recent advances in understanding the neural mechanisms controlling cataplexy, with a focus on the involvement of orexin/hypocretin system, and will discuss future experimental strategies that will lead to further understanding and treatment of this disease.
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Affiliation(s)
- Yoshimasa Koyama
- Faculty of Symbiotic Systems Science, Fukushima University, 1 Kanaya-gawa, Fukushima 960-1296, Japan..
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Kim SY, Shin DW, Hyun J, Kwon NH, Cheong JC, Paeng KJ, Lee J, Kim JY. Uncertainty Evaluation for the Quantification of Urinary Amphetamine and 4-Hydroxyamphetamine Using Liquid Chromatography-Tandem Mass Spectrometry: Comparison of the Guide to the Expression of Uncertainty in Measurement Approach and the Monte Carlo Method with R. Molecules 2023; 28:6803. [PMID: 37836646 PMCID: PMC10574584 DOI: 10.3390/molecules28196803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 09/21/2023] [Accepted: 09/22/2023] [Indexed: 10/15/2023] Open
Abstract
Estimating the measurement uncertainty (MU) is becoming increasingly mandatory in analytical toxicology. This study evaluates the uncertainty in the quantitative determination of urinary amphetamine (AP) and 4-hydroxyamphetamine (4HA) using a liquid chromatography-tandem mass spectrometry (LC-MS/MS) method based on the dilute-and-shoot approach. Urine sample dilution, preparation of calibrators, calibration curve, and method repeatability were identified as the sources of uncertainty. To evaluate the MU, the Guide to the Expression of Uncertainty in Measurement (GUM) approach and the Monte Carlo method (MCM) were compared using the R programming language. The MCM afforded a smaller coverage interval for both AP (94.83, 104.74) and 4HA (10.52, 12.14) than that produced by the GUM (AP (92.06, 107.41) and 4HA (10.21, 12.45)). The GUM approach offers an underestimated coverage interval for Type A evaluation, whereas the MCM provides an exact coverage interval under an abnormal probability distribution of the measurand. The MCM is useful in complex settings where the measurand is combined with numerous distributions because it is generated from the uncertainties of input quantities based on the propagation of the distribution. Therefore, the MCM is more practical than the GUM for evaluating the MU of urinary AP and 4HA concentrations using LC-MS/MS.
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Affiliation(s)
- Seon Yeong Kim
- Forensic Genetics & Chemistry Division, Supreme Prosecutors’ Office, Seoul 06590, Republic of Korea
| | - Dong Won Shin
- Forensic Genetics & Chemistry Division, Supreme Prosecutors’ Office, Seoul 06590, Republic of Korea
| | - Jihye Hyun
- Department of Applied Statistics, Chung-Ang University, Seoul 06590, Republic of Korea;
| | - Nam Hee Kwon
- Forensic Genetics & Chemistry Division, Supreme Prosecutors’ Office, Seoul 06590, Republic of Korea
| | - Jae Chul Cheong
- Forensic Genetics & Chemistry Division, Supreme Prosecutors’ Office, Seoul 06590, Republic of Korea
| | - Ki-Jung Paeng
- Department of Chemistry, Yonsei University, Wonju 26493, Republic of Korea
| | - Jooyoung Lee
- Department of Applied Statistics, Chung-Ang University, Seoul 06590, Republic of Korea;
| | - Jin Young Kim
- Forensic Genetics & Chemistry Division, Supreme Prosecutors’ Office, Seoul 06590, Republic of Korea
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Kassim FM, Lahooti SK, Keay EA, Iyyalol R, Rodger J, Albrecht MA, Martin-Iverson MT. Dexamphetamine widens temporal and spatial binding windows in healthy participants. J Psychiatry Neurosci 2023; 48:E90-E98. [PMID: 36918195 PMCID: PMC10019325 DOI: 10.1503/jpn.220149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 09/28/2022] [Accepted: 11/11/2022] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND The pathophysiology of psychosis is complex, but a better understanding of stimulus binding windows (BWs) could help to improve our knowledge base. Previous studies have shown that dopamine release is associated with psychosis and widened BWs. We can probe BW mechanisms using drugs of specific interest to psychosis. Therefore, we were interested in understanding how manipulation of the dopamine or catecholamine systems affect psychosis and BWs. We aimed to investigate the effect of dexamphetamine, as a dopamine-releasing stimulant, on the BWs in a unimodal illusion: the tactile funneling illusion (TFI). METHODS We conducted a randomized, double-blind, counterbalanced placebo-controlled crossover study to investigate funnelling and errors of localization. We administered dexamphetamine (0.45 mg/kg) to 46 participants. We manipulated 5 spatial (5-1 cm) and 3 temporal (0, 500 and 750 ms) conditions in the TFI. RESULTS We found that dexamphetamine increased funnelling illusion (p = 0.009) and increased the error of localization in a delay-dependent manner (p = 0.03). We also found that dexamphetamine significantly increased the error of localization at 500 ms temporal separation and 4 cm spatial separation (p interaction = 0.009; p 500ms|4cm v. baseline = 0.01). LIMITATIONS Although amphetamine-induced models of psychosis are a useful approach to understanding the physiology of psychosis related to dopamine hyperactivity, dexamphetamine is equally effective at releasing noradrenaline and dopamine, and, therefore, we were unable to tease apart the effects of the 2 systems on BWs in our study. CONCLUSION We found that dexamphetamine increases illusory perception on the unimodal TFI in healthy participants, which suggests that dopamine or other catecholamines have a role in increasing tactile spatial and temporal BWs.
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Affiliation(s)
- Faiz M Kassim
- From the Department of Psychiatry, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia (Kassim); the Psychopharmacology Unit, School of Biomedical Sciences, University of Western Australia, Perth, WA, Australia (Kassim, Lahooti, Keay, Martin-Iverson); the Psychiatry, Graylands Hospital, Mt Claremont, Perth, WA, Australia (Iyyalol); the Experimental and Regenerative Neurosciences, School of Biological Sciences, University of Western Australia, Crawley, WA, Australia (Rodger); the Brain Plasticity Group, Perron Institute for Neurological and Translational Science, Nedlands, WA, Australia (Rodger); the Western Australian Centre for Road Safety Research, School of Psychological Science, University of Western Australia, Perth, WA, Australia (Albrecht)
| | - Samra Krakonja Lahooti
- From the Department of Psychiatry, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia (Kassim); the Psychopharmacology Unit, School of Biomedical Sciences, University of Western Australia, Perth, WA, Australia (Kassim, Lahooti, Keay, Martin-Iverson); the Psychiatry, Graylands Hospital, Mt Claremont, Perth, WA, Australia (Iyyalol); the Experimental and Regenerative Neurosciences, School of Biological Sciences, University of Western Australia, Crawley, WA, Australia (Rodger); the Brain Plasticity Group, Perron Institute for Neurological and Translational Science, Nedlands, WA, Australia (Rodger); the Western Australian Centre for Road Safety Research, School of Psychological Science, University of Western Australia, Perth, WA, Australia (Albrecht)
| | - Elizabeth Ann Keay
- From the Department of Psychiatry, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia (Kassim); the Psychopharmacology Unit, School of Biomedical Sciences, University of Western Australia, Perth, WA, Australia (Kassim, Lahooti, Keay, Martin-Iverson); the Psychiatry, Graylands Hospital, Mt Claremont, Perth, WA, Australia (Iyyalol); the Experimental and Regenerative Neurosciences, School of Biological Sciences, University of Western Australia, Crawley, WA, Australia (Rodger); the Brain Plasticity Group, Perron Institute for Neurological and Translational Science, Nedlands, WA, Australia (Rodger); the Western Australian Centre for Road Safety Research, School of Psychological Science, University of Western Australia, Perth, WA, Australia (Albrecht)
| | - Rajan Iyyalol
- From the Department of Psychiatry, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia (Kassim); the Psychopharmacology Unit, School of Biomedical Sciences, University of Western Australia, Perth, WA, Australia (Kassim, Lahooti, Keay, Martin-Iverson); the Psychiatry, Graylands Hospital, Mt Claremont, Perth, WA, Australia (Iyyalol); the Experimental and Regenerative Neurosciences, School of Biological Sciences, University of Western Australia, Crawley, WA, Australia (Rodger); the Brain Plasticity Group, Perron Institute for Neurological and Translational Science, Nedlands, WA, Australia (Rodger); the Western Australian Centre for Road Safety Research, School of Psychological Science, University of Western Australia, Perth, WA, Australia (Albrecht)
| | - Jennifer Rodger
- From the Department of Psychiatry, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia (Kassim); the Psychopharmacology Unit, School of Biomedical Sciences, University of Western Australia, Perth, WA, Australia (Kassim, Lahooti, Keay, Martin-Iverson); the Psychiatry, Graylands Hospital, Mt Claremont, Perth, WA, Australia (Iyyalol); the Experimental and Regenerative Neurosciences, School of Biological Sciences, University of Western Australia, Crawley, WA, Australia (Rodger); the Brain Plasticity Group, Perron Institute for Neurological and Translational Science, Nedlands, WA, Australia (Rodger); the Western Australian Centre for Road Safety Research, School of Psychological Science, University of Western Australia, Perth, WA, Australia (Albrecht)
| | - Matthew A Albrecht
- From the Department of Psychiatry, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia (Kassim); the Psychopharmacology Unit, School of Biomedical Sciences, University of Western Australia, Perth, WA, Australia (Kassim, Lahooti, Keay, Martin-Iverson); the Psychiatry, Graylands Hospital, Mt Claremont, Perth, WA, Australia (Iyyalol); the Experimental and Regenerative Neurosciences, School of Biological Sciences, University of Western Australia, Crawley, WA, Australia (Rodger); the Brain Plasticity Group, Perron Institute for Neurological and Translational Science, Nedlands, WA, Australia (Rodger); the Western Australian Centre for Road Safety Research, School of Psychological Science, University of Western Australia, Perth, WA, Australia (Albrecht)
| | - Mathew T Martin-Iverson
- From the Department of Psychiatry, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia (Kassim); the Psychopharmacology Unit, School of Biomedical Sciences, University of Western Australia, Perth, WA, Australia (Kassim, Lahooti, Keay, Martin-Iverson); the Psychiatry, Graylands Hospital, Mt Claremont, Perth, WA, Australia (Iyyalol); the Experimental and Regenerative Neurosciences, School of Biological Sciences, University of Western Australia, Crawley, WA, Australia (Rodger); the Brain Plasticity Group, Perron Institute for Neurological and Translational Science, Nedlands, WA, Australia (Rodger); the Western Australian Centre for Road Safety Research, School of Psychological Science, University of Western Australia, Perth, WA, Australia (Albrecht)
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5
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Kassim FM, Mark Lim JH, Albrecht MA, Martin-Iverson MT. Dexamphetamine influences funneling illusion based on psychometric score. Hum Psychopharmacol 2023; 38:e2862. [PMID: 36799101 DOI: 10.1002/hup.2862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 02/01/2023] [Accepted: 02/03/2023] [Indexed: 02/18/2023]
Abstract
OBJECTIVES Our team previously showed that like the experience of the rubber hand illusion (RHI) in people with schizophrenia and their offspring¸ dexamphetamine administration to healthy volunteers increases the stimulus binding windows (BWs) in RHI. It is not clear if similar expansions of BWs are present for unimodal illusions. Studies have also shown that subjective or objective effects of amphetamine would be linked to between-person variations in personality measures. Therefore, we aimed to examine the effect of dexamphetamine (DEX), a dopamine-releasing stimulant, on illusory perception using unimodal sensory stimuli (Tactile Funneling Illusion [TFI]) across both temporal and spatial variables. We further examined the relationship between changes in psychometric scores and changes in illusion perception induced by dexamphetamine. METHODS Healthy subjects (N = 20) participated in a randomized, double-blind, counter-balanced, placebo-controlled, cross-over study. The effects of dexamphetamine (0.45 mg/kg, PO, q.d.) on funneling and error of spatial localization (EL) were examined using TFI. Psychotomimetic effects were assessed using a battery of psychological measures. RESULTS Dexamphetamine did not significantly increased the funneling illusion (p = 0.88) or EL (p = 0.5), relative to placebo. However, the degree of change in psychometric scores following dexamphetamine positively correlated with changes in funneling (ρ = 0.48, p = 0.03, n = 20), mainly at 0 ms delay condition (ρ = 0.6, p = 0.004, n = 20). CONCLUSION Unlike multimodal illusions, alteration of BWs does not occur for unimodal illusions after administration of a dopamine-releasing agent. However, our findings indicate that moderate release of dopamine, through its psychotomimetic effect, indirectly influences unimodal illusion.
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Affiliation(s)
- Faiz M Kassim
- Neuropsychopharmacology Research Unit, School of Biomedical Sciences, University of Western Australia, Perth, Western Australia, Australia
| | - J H Mark Lim
- Neuropsychopharmacology Research Unit, School of Biomedical Sciences, University of Western Australia, Perth, Western Australia, Australia
| | - Matthew A Albrecht
- Western Australian Centre for Road Safety Research, School of Psychological Sciences, University of Western Australia, Perth, Western Australia, Australia
| | - Mathew T Martin-Iverson
- Neuropsychopharmacology Research Unit, School of Biomedical Sciences, University of Western Australia, Perth, Western Australia, Australia
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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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Bassetti CLA, Kallweit U, Vignatelli L, Plazzi G, Lecendreux M, Baldin E, Dolenc-Groselj L, Jennum P, Khatami R, Manconi M, Mayer G, Partinen M, Pollmächer T, Reading P, Santamaria J, Sonka K, Dauvilliers Y, Lammers GJ. European guideline and expert statements on the management of narcolepsy in adults and children. J Sleep Res 2021; 30:e13387. [PMID: 34173288 DOI: 10.1111/jsr.13387] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 04/21/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND PURPOSE Narcolepsy is an uncommon hypothalamic disorder of presumed autoimmune origin that usually requires lifelong treatment. This paper aims to provide evidence-based guidelines for the management of narcolepsy in both adults and children. METHODS The European Academy of Neurology (EAN), European Sleep Research Society (ESRS), and European Narcolepsy Network (EU-NN) nominated a task force of 18 narcolepsy specialists. According to the EAN recommendations, 10 relevant clinical questions were formulated in PICO format. Following a systematic review of the literature (performed in Fall 2018 and updated in July 2020) recommendations were developed according to the GRADE approach. RESULTS A total of 10,247 references were evaluated, 308 studies were assessed and 155 finally included. The main recommendations can be summarized as follows: (i) excessive daytime sleepiness (EDS) in adults-scheduled naps, modafinil, pitolisant, sodium oxybate (SXB), solriamfetol (all strong); methylphenidate, amphetamine derivatives (both weak); (ii) cataplexy in adults-SXB, venlafaxine, clomipramine (all strong) and pitolisant (weak); (iii) EDS in children-scheduled naps, SXB (both strong), modafinil, methylphenidate, pitolisant, amphetamine derivatives (all weak); (iv) cataplexy in children-SXB (strong), antidepressants (weak). Treatment choices should be tailored to each patient's symptoms, comorbidities, tolerance and risk of potential drug interactions. CONCLUSION The management of narcolepsy involves non-pharmacological and pharmacological approaches with an increasing number of symptomatic treatment options for adults and children that have been studied in some detail.
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Affiliation(s)
- Claudio L A Bassetti
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Ulf Kallweit
- Center for Narcolepsy/Hypersomnias, Clin. Sleep and Neuroimmunology, Institute of Immunology, University Witten/Herdecke, Witten, Germany
| | - Luca Vignatelli
- IRCCS, Istituto delle Scienze Neurologiche di Bologna, UOC Clinica Neurologica, Bologna, Italy
| | - Giuseppe Plazzi
- IRCCS, Istituto delle Scienze Neurologiche di Bologna, UOC Clinica Neurologica, Bologna, Italy.,Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Michel Lecendreux
- AP-HP, Pediatric Sleep Center, CHU Robert-Debré, Paris, France.,National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic Hypersomnia and Kleine-Levin Syndrome (CNR narcolepsie-hypersomnie), Paris, France
| | - Elisa Baldin
- IRCCS, Istituto delle Scienze Neurologiche di Bologna, UOC Clinica Neurologica, Bologna, Italy
| | - Leja Dolenc-Groselj
- Institute of Clinical Neurophysiology, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Department of Neurology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Poul Jennum
- Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Faculty of Health Sciences, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Ramin Khatami
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.,Center of Sleep Medicine, Sleep Research and Epileptology, Clinic Barmelweid, Barmelweid, Switzerland
| | - Mauro Manconi
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.,Sleep Center, Faculty of Biomedical Sciences, Neurocenter of Southern Switzerland, Università della Svizzera Italiana, Lugano, Switzerland
| | - Geert Mayer
- Neurology Department, Hephata Klinik, Schwalmstadt, Germany.,Department of Neurology, Philipps-Universität Marburg, Marburg, Germany
| | - Markku Partinen
- Department of Clinial Neurosciences, Clinicum, Helsinki Sleep Clinic, Vitalmed Research Center, Terveystalo Biobank and Clinical Research, University of Helsinki, Helsinki, Finland
| | | | - Paul Reading
- Department of Neurology, James Cook University Hospital, Middlesbrough, UK
| | - Joan Santamaria
- Neurology Service, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Karel Sonka
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Yves Dauvilliers
- National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic Hypersomnia, Sleep Unit, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier, University of Montpellier, INM INSERM, Montpellier, France
| | - Gert J Lammers
- Sleep Wake Centre SEIN, Heemstede, The Netherlands.,Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands
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8
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Bassetti CLA, Kallweit U, Vignatelli L, Plazzi G, Lecendreux M, Baldin E, Dolenc-Groselj L, Jennum P, Khatami R, Manconi M, Mayer G, Partinen M, Pollmächer T, Reading P, Santamaria J, Sonka K, Dauvilliers Y, Lammers GJ. European guideline and expert statements on the management of narcolepsy in adults and children. Eur J Neurol 2021; 28:2815-2830. [PMID: 34173695 DOI: 10.1111/ene.14888] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 04/18/2021] [Accepted: 04/20/2021] [Indexed: 01/29/2023]
Abstract
BACKGROUND AND AIM Narcolepsy is an uncommon hypothalamic disorder of presumed autoimmune origin that usually requires lifelong treatment. This paper aims to provide evidence-based guidelines for the management of narcolepsy in both adults and children. METHODS The European Academy of Neurology (EAN), European Sleep Research Society (ESRS) and European Narcolepsy Network (EU-NN) nominated a task force of 18 narcolepsy specialists. According to the EAN recommendations, 10 relevant clinical questions were formulated in PICO format. Following a systematic review of the literature (performed in Fall 2018 and updated in July 2020) recommendations were developed according to the GRADE approach. RESULTS A total of 10,247 references were evaluated, 308 studies were assessed and 155 finally included. The main recommendations can be summarized as follows: (i) excessive daytime sleepiness in adults-scheduled naps, modafinil, pitolisant, sodium oxybate (SXB), solriamfetol (all strong), methylphenidate, amphetamine derivates (both weak); (ii) cataplexy in adults-SXB, venlafaxine, clomipramine (all strong) and pitolisant (weak); (iii) excessive daytime sleepiness in children-scheduled naps, SXB (both strong), modafinil, methylphenidate, pitolisant, amphetamine derivates (all weak); (iv) cataplexy in children-SXB (strong), antidepressants (weak). Treatment choices should be tailored to each patient's symptoms, comorbidities, tolerance and risk of potential drug interactions. CONCLUSION The management of narcolepsy involves non-pharmacological and pharmacological approaches with an increasing number of symptomatic treatment options for adults and children that have been studied in some detail.
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Affiliation(s)
- Claudio L A Bassetti
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Ulf Kallweit
- Center for Narcolepsy/Hypersomnias, Clin. Sleep and Neuroimmunology, Institute of Immunology, University Witten/Herdecke, Witten, Germany
| | - Luca Vignatelli
- IRCCS, Istituto delle Scienze Neurologiche di Bologna, UOC Clinica Neurologica, Bologna, Italy
| | - Giuseppe Plazzi
- IRCCS, Istituto delle Scienze Neurologiche di Bologna, UOC Clinica Neurologica, Bologna, Italy.,Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Michel Lecendreux
- AP-HP, Pediatric Sleep Center, CHU Robert-Debré, Paris, France.,National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic Hypersomnia and Kleine-Levin Syndrome (CNR narcolepsie-hypersomnie), Paris, France
| | - Elisa Baldin
- IRCCS, Istituto delle Scienze Neurologiche di Bologna, UOC Clinica Neurologica, Bologna, Italy
| | - Leja Dolenc-Groselj
- Institute of Clinical Neurophysiology, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Department of Neurology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Poul Jennum
- Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Faculty of Health Sciences, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Ramin Khatami
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.,Center of Sleep Medicine, Sleep Research and Epileptology. Clinic Barmelweid, Barmelweid, Switzerland
| | - Mauro Manconi
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.,Sleep Center, Faculty of Biomedical Sciences, Neurocenter of Southern Switzerland, Università della Svizzera Italiana, Lugano, Switzerland
| | - Geert Mayer
- Neurology Department, Hephata Klinik, Schwalmstadt, Germany.,Department of Neurology, Philipps-Universität Marburg, Marburg, Germany
| | - Markku Partinen
- Department of Clinial Neurosciences, Clinicum, Helsinki Sleep Clinic, Vitalmed Research Center, Terveystalo Biobank and Clinical Research, University of Helsinki, Helsinki, Finland
| | | | - Paul Reading
- Department of Neurology, James Cook University Hospital, Middlesbrough, UK
| | - Joan Santamaria
- Neurology Service, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Karel Sonka
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Yves Dauvilliers
- National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic Hypersomnia, Sleep Unit, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier, University of Montpellier, INM INSERM, Montpellier, France
| | - Gert J Lammers
- Sleep Wake Centre SEIN, Heemstede, The Netherlands.,Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands
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9
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Blasius CK, Heinrich NF, Vasilenko V, Gade LH. Tackling
N
‐Alkyl Imines with 3d Metal Catalysis: Highly Enantioselective Iron‐Catalyzed Synthesis of α‐Chiral Amines. Angew Chem Int Ed Engl 2020. [DOI: 10.1002/ange.202006557] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Clemens K. Blasius
- Anorganisch-Chemisches Institut Universität Heidelberg Im Neuenheimer Feld 270 69120 Heidelberg Germany
| | - Niklas F. Heinrich
- Anorganisch-Chemisches Institut Universität Heidelberg Im Neuenheimer Feld 270 69120 Heidelberg Germany
| | - Vladislav Vasilenko
- Anorganisch-Chemisches Institut Universität Heidelberg Im Neuenheimer Feld 270 69120 Heidelberg Germany
| | - Lutz H. Gade
- Anorganisch-Chemisches Institut Universität Heidelberg Im Neuenheimer Feld 270 69120 Heidelberg Germany
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10
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Blasius CK, Heinrich NF, Vasilenko V, Gade LH. Tackling N-Alkyl Imines with 3d Metal Catalysis: Highly Enantioselective Iron-Catalyzed Synthesis of α-Chiral Amines. Angew Chem Int Ed Engl 2020; 59:15974-15977. [PMID: 32453491 PMCID: PMC7539954 DOI: 10.1002/anie.202006557] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Indexed: 12/20/2022]
Abstract
A readily activated iron alkyl precatalyst effectively catalyzes the highly enantioselective hydroboration of N-alkyl imines. Employing a chiral bis(oxazolinylmethylidene)isoindoline pincer ligand, the asymmetric reduction of various acyclic N-alkyl imines provided the corresponding α-chiral amines in excellent yields and with up to >99 % ee. The applicability of this base metal catalytic system was further demonstrated with the synthesis of the pharmaceuticals Fendiline and Tecalcet.
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Affiliation(s)
- Clemens K. Blasius
- Anorganisch-Chemisches InstitutUniversität HeidelbergIm Neuenheimer Feld 27069120HeidelbergGermany
| | - Niklas F. Heinrich
- Anorganisch-Chemisches InstitutUniversität HeidelbergIm Neuenheimer Feld 27069120HeidelbergGermany
| | - Vladislav Vasilenko
- Anorganisch-Chemisches InstitutUniversität HeidelbergIm Neuenheimer Feld 27069120HeidelbergGermany
| | - Lutz H. Gade
- Anorganisch-Chemisches InstitutUniversität HeidelbergIm Neuenheimer Feld 27069120HeidelbergGermany
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11
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Salomó E, Gallen A, Sciortino G, Ujaque G, Grabulosa A, Lledós A, Riera A, Verdaguer X. Direct Asymmetric Hydrogenation of N-Methyl and N-Alkyl Imines with an Ir(III)H Catalyst. J Am Chem Soc 2018; 140:16967-16970. [PMID: 30475609 DOI: 10.1021/jacs.8b11547] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
A novel cationic [IrH(THF)(P,N)(imine)] [BArF] catalyst containing a P-stereogenic MaxPHOX ligand is described for the direct asymmetric hydrogenation of N-methyl and N-alkyl imines. This is the first catalytic system to attain high enantioselectivity (up to 94% ee) in this type of transformation. The labile tetrahydrofuran ligand allows for effective activation and reactivity, even at low temperatures. Density functional theory calculations allowed the rationalization of the stereochemical course of the reaction.
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Affiliation(s)
- Ernest Salomó
- Institute for Research in Biomedicine (IRB Barcelona), Barcelona Institute of Science and Technology , Baldiri Reixac 10 , 08028 Barcelona , Spain
| | - Albert Gallen
- Dept. Química Inorgànica i Orgànica , Universitat de Barcelona , Martí i Franquès 1 , 08028 Barcelona , Spain
| | - Giuseppe Sciortino
- Dept. de Química, Ed. C.n. , Universitat Autònoma de Barcelona , Cerdanyola del Vallès , Barcelona 08193 , Spain.,Dipt. di Chimica e Farmacia , Università di Sassari , via Vienna 2 , I-07017 Sassari , Italy
| | - Gregori Ujaque
- Dept. de Química, Ed. C.n. , Universitat Autònoma de Barcelona , Cerdanyola del Vallès , Barcelona 08193 , Spain
| | - Arnald Grabulosa
- Dept. Química Inorgànica i Orgànica , Universitat de Barcelona , Martí i Franquès 1 , 08028 Barcelona , Spain
| | - Agustí Lledós
- Dept. de Química, Ed. C.n. , Universitat Autònoma de Barcelona , Cerdanyola del Vallès , Barcelona 08193 , Spain
| | - Antoni Riera
- Institute for Research in Biomedicine (IRB Barcelona), Barcelona Institute of Science and Technology , Baldiri Reixac 10 , 08028 Barcelona , Spain.,Dept. Química Inorgànica i Orgànica , Universitat de Barcelona , Martí i Franquès 1 , 08028 Barcelona , Spain
| | - Xavier Verdaguer
- Institute for Research in Biomedicine (IRB Barcelona), Barcelona Institute of Science and Technology , Baldiri Reixac 10 , 08028 Barcelona , Spain.,Dept. Química Inorgànica i Orgànica , Universitat de Barcelona , Martí i Franquès 1 , 08028 Barcelona , Spain
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12
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Abstract
Cataplexy is defined as episodes of sudden loss of voluntary muscle tone triggered by emotions generally lasting <2 minutes. Cataplexy is most commonly associated with and considered pathognomonic for narcolepsy, a sleep disorder affecting ~0.05% of the general population. Knowledge of the pathophysiology of cataplexy has advanced through study of canine, murine, and human models. It is now generally considered that loss of signaling by hypothalamic hypocretin/orexin-producing neurons plays a key role in the development of cataplexy. Although the cause of hypocretin/orexin neuron loss in narcolepsy with cataplexy is unknown, an autoimmune etiology is widely hypothesized. Despite these advances, a literature review shows that treatment of cataplexy remains limited. Multiple classes of antidepressants have been commonly used off-label for cataplexy in narcolepsy and are suggested for this use in expert consensus guidelines based on traditional practice, case reports, and small trials. However, systematic research evidence supporting antidepressants for cataplexy is lacking. The single pharmacotherapy indicated for cataplexy and the guideline-recommended first-line treatment in Europe and the US is sodium oxybate, the sodium salt of gamma-hydroxybutyrate. Clinical trial evidence of its efficacy and safety in cataplexy is robust, and it is hypothesized that its therapeutic effects may occur through gamma-aminobutyric acid receptor type B-mediated effects at noradrenergic, dopaminergic, and thalamocortical neurons. Additional possible mechanisms for cataplexy therapy suggested by preliminary research include antagonism of the histamine H3 autoreceptor with pitolisant and intravenous immunoglobulin therapy for amelioration of the presumed autoimmune-mediated hypocretin/orexin cell loss. Further research and development of therapeutic approaches to cataplexy are needed.
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Affiliation(s)
- Todd J Swick
- Department of Neurology, University of Texas School of Medicine-Houston, Houston, TX, USA ; The Sleep Center at North Cypress Medical Center, Cypress, TX, USA ; Apnix Sleep Diagnostics, Houston, TX, USA ; Neurology and Sleep Medicine Consultants, Houston, TX, USA
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13
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Maintenance of wakefulness with lisdexamfetamine dimesylate, compared with placebo and armodafinil in healthy adult males undergoing acute sleep loss. J Clin Psychopharmacol 2014; 34:690-6. [PMID: 25159886 DOI: 10.1097/jcp.0000000000000202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This study evaluated daytime alertness and performance with lisdexamfetamine dimesylate during acute sleep loss. In a randomized, double-blind study in healthy adult men (n = 135) undergoing 24-hour sleep loss, the alerting effects of single oral lisdexamfetamine dimesylate doses (20, 50, or 70 mg) were compared with a placebo and an active control (armodafinil 250 mg). Primary end point was mean unequivocal sleep latency on the 30-minute maintenance of wakefulness test taken every 2 hours from midnight to 8:00 A.M. Secondary end points included the Karolinska sleepiness scale and psychomotor vigilance task. Safety assessments included treatment-emergent adverse events (TEAEs) and vital signs. Least squares mean (SE) maintenance of wakefulness test unequivocal sleep latency (in minutes) was longer with lisdexamfetamine dimesylate 20, 50, and 70 mg, or armodafinil 250 mg (23.3 [1.10], 27.9 [0.64], 29.3 [0.44], or 27.6 [0.63], respectively) versus placebo (15.3 [1.00]; P < 0.0001). Longer mean unequivocal sleep latency was seen with lisdexamfetamine dimesylate 70 mg versus armodafinil (P = 0.0351) and armodafinil versus lisdexamfetamine dimesylate 20 mg (P = 0.0014). On Karolinska sleepiness scale, lisdexamfetamine dimesylate 50 and 70 mg improved estimated sleepiness versus placebo (P ≤ 0.0002) and armodafinil (P ≤ 0.03). Active treatments improved psychomotor vigilance task performance versus placebo (P < 0.0001). The TEAEs were mild/moderate. No serious adverse events occurred. The most common TEAE was headache with lisdexamfetamine dimesylate and armodafinil (7.4% each) versus placebo (3.7%). Small mean increases in vital signs were observed with lisdexamfetamine dimesylate and armodafinil. In sleep-deprived healthy men, alertness was greater with lisdexamfetamine dimesylate and armodafinil versus placebo on the primary end point. Studies are needed in clinical populations and using longer durations of administration.
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14
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Burrai L, Nieddu M, Pirisi MA, Carta A, Briguglio I, Boatto G. Enantiomeric Separation of 13 New Amphetamine-Like Designer Drugs by Capillary Electrophoresis, Using Modified--Cyclodextrins. Chirality 2013; 25:617-21. [DOI: 10.1002/chir.22185] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Accepted: 04/02/2013] [Indexed: 11/06/2022]
Affiliation(s)
- Lucia Burrai
- Dipartimento di Chimica e Farmacia; Università degli Studi di Sassari; Sassari Italy
| | - Maria Nieddu
- Dipartimento di Chimica e Farmacia; Università degli Studi di Sassari; Sassari Italy
| | | | - Antonio Carta
- Dipartimento di Chimica e Farmacia; Università degli Studi di Sassari; Sassari Italy
| | - Irene Briguglio
- Dipartimento di Chimica e Farmacia; Università degli Studi di Sassari; Sassari Italy
| | - Gianpiero Boatto
- Dipartimento di Chimica e Farmacia; Università degli Studi di Sassari; Sassari Italy
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15
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Wongwan S, Scriba GKE. Impurity profiling of dexamphetamine sulfate by cyclodextrin-modified microemulsion electrokinetic chromatography. Electrophoresis 2010; 31:3006-11. [DOI: 10.1002/elps.201000277] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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16
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Wongwan S, Sungthong B, Scriba GKE. CE assay for simultaneous determination of charged and neutral impurities in dexamphetamine sulfate using a dual CD system. Electrophoresis 2010; 31:1475-81. [PMID: 20358547 DOI: 10.1002/elps.200900724] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
A CE assay for the simultaneous determination of charged and uncharged potential impurities (1S,2S-(+)-norpseudoephedrine, 1R,2S-(-)-norephedrine, phenylacetone and phenylacetone oxime) of dexamphetamine sulfate including the stereoisomer levoamphetamine was developed and validated. The optimized background electrolyte consisted of a 50 mM sodium phosphate buffer, pH 3.0, containing 80 mg/mL sulfobutylether-beta-CD and 25 mg/mL sulfated beta-CD. Separations were performed in 40.2/35 cm, 50 mum id fused-silica capillaries at a temperature of 20 degrees C and an applied voltage of -10 kV. 1R,2S-(-)-ephedrine was used as internal standard. The assay was validated in the range of 0.05-1.0% for the related substances and in the range of 0.05-5.0% for levoamphetamine. The LOD was 0.01-0.02% depending on the analyte. The assay also allowed the separation of the E,Z-stereoisomers of phenylacetone oxime. The effect of the degree of substitution of sulfobutylether-beta-CD was investigated. In commercial samples of dexamphetamine sulfate between 3.2 and 3.7% of levoamphetamine were found. Furthermore, phenylacetone and phenylacetone oxime could be observed at the LOD, indicating the synthetic origin of the investigated samples.
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Affiliation(s)
- Sudaporn Wongwan
- Department of Medicinal/Pharmaceutical Chemistry, Friedrich Schiller University Jena, Jena, Germany
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17
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Kokiashvili NG, Wongwan S, Landgraf C, Michaelis K, Hammitzsch-Wiedemann M, Scriba GK. Profiling of levoamphetamine and related substances in dexamphetamine sulfate by capillary electrophoresis. J Pharm Biomed Anal 2009; 50:1050-3. [DOI: 10.1016/j.jpba.2009.06.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2009] [Revised: 06/02/2009] [Accepted: 06/06/2009] [Indexed: 11/15/2022]
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18
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Nishino S, Okura M, Mignot E. Narcolepsy: genetic predisposition and neuropharmacological mechanisms. REVIEW ARTICLE. Sleep Med Rev 2000; 4:57-99. [PMID: 12531161 DOI: 10.1053/smrv.1999.0069] [Citation(s) in RCA: 83] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Narcolepsy is a disabling sleep disorder characterized by excessive daytime somnolence (EDS), cataplexy and REM sleep-related abnormalities. It is a frequently-occurring but under-diagnosed condition that affects 0.02 to 0.18% of the general population in various countries. Although most cases occur sporadically, familial clustering may be observed; the risk of a first-degree relative of a narcoleptic developing narcolepsy is 10-40 times higher than in the general population. The disorder is tightly associated with the specific human leukocyte antigen (HLA) allele, DQB1*0602 [most often in combination with HLA-DR2 (DRB1*15)]. Genetic transmission is, however, likely to be polygenic in most cases, and genetic factors other than HLA-DQ are also likely to be implicated. In addition, environmental factors are involved in disease predisposition; most monozygotic twins pairs reported in the literature are discordant for narcolepsy. Narcolepsy was reported to exist in canines in the early 1970s. Both sporadic and familial cases are also observed in this animal species. A highly-penetrant single autosomal recessive gene, canarc-1, is involved in the transmission of narcolepsy in Doberman pinschers and Labrador retrievers. Positional cloning of this gene is in progress, and a human homologue of this gene, or a gene with a functional relationship to canarc-1, might be involved in some human cases. Human narcolepsy is currently treated with central nervous system (CNS) stimulants for EDS and antidepressants for cataplexy and abnormal REM sleep. These treatments are purely symptomatic and induce numerous side effects. These compounds disturb nocturnal sleep in many patients, and tolerance may develop as a result of continuous treatment. The canine model is an invaluable resource for studying the pharmacological and physiological control of EDS and cataplexy. Experiments using canine narcolepsy have demonstrated that increased cholinergic and decreased monoaminergic transmission are likely to be at the basis of the pathophysiology of the disorder. Pharmacological studies have shown that blockade of norepinephrine uptake mediates the anticataplectic effect of currently prescribed antidepressants, while blockade of dopamine uptake and/or stimulation of dopamine release mediates the awake-promoting effect of CNS stimulants. Studies in canine narcolepsy also suggest that mechanisms and brain sites for triggering cataplexy are not identical to those regulating REM sleep. It may thus be possible to develop new pharmacological compounds that specifically target abnormal symptoms in narcolepsy, but do not disturb physiological sleep/wake cycles. (See also postscript remarks).
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Affiliation(s)
- Seiji Nishino
- Center for Narcolepsy, Department of Psychiatry & Behavioral Sciences, Stanford University Medical Center/Sleep Research Center, Palo Alto, CA, USA
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19
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Nishino S, Mignot E. Drug treatment of patients with insomnia and excessive daytime sleepiness: pharmacokinetic considerations. Clin Pharmacokinet 1999; 37:305-30. [PMID: 10554047 DOI: 10.2165/00003088-199937040-00003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Insomnia and excessive daytime sleepiness (EDS) are frequently observed conditions in the general public. A national survey in the USA in 1979 indicated that 35% of American adults experience insomnia in the course of a year. The prevalence of EDS varies depending on the survey (0.3 to 13.3%), but a recent study stated that 2.4% of individuals reported that they continually fell asleep at work. These problems are often long term and negatively affect the individuals' quality of life. People with these sleep problems often have difficulties maintaining high levels of productivity at work or pursuing their daily activities; individuals with insomnia lack the feeling of being rested or refreshed in the morning and EDS is unavoidable in most cases. Behavioural therapy has been shown to be effective for many people affected with insomnia and EDS. However, pharmacological treatments using hypnosedatives and central nervous system (CNS) stimulants are usually necessary, and effective, for those with more severe cases. These compounds have thus been widely prescribed in clinical practice (e.g., 2.6% of all adults surveyed used medically prescribed hypnosedatives and 4.5% used over-the-counter drugs to promote sleep). The onset and duration of action of these hypnosedatives and CNS stimulant drugs are important factors to be considered when prescribing these compounds. These factors primarily depend on physicochemical properties (lipid solubility and protein binding), as well as the pharmacokinetic profile (absorption, distribution, elimination and clearance) of the compounds. Significant differences in profile exist amongst hypnosedatives and CNS stimulants, and these differences may account for the observed variations in clinical action and adverse effects during and after treatment. In this review, we will introduce recently obtained knowledge of the pharmacokinetics of hypnosedatives and CNS stimulants and their applications for patients affected with insomnia and EDS.
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Affiliation(s)
- S Nishino
- Stanford Center for Narcolepsy, Stanford University, School of Medicine, Palo Alto, California 94304, USA.
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20
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Wallin MT, Mahowald MW. Blood pressure effects of long-term stimulant use in disorders of hypersomnolence. J Sleep Res 1998; 7:209-15. [PMID: 9785276 DOI: 10.1046/j.1365-2869.1998.00110.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Untoward cardiovascular effects have been implicated as a deterrent to long-term central nervous system (CNS) stimulant use in disorders of hypersomnolence. In this study, we reviewed the relationship between blood pressure and long-term stimulant use. Medical records of 54 patients with narcolepsy and idiopathic CNS hypersomnolence (ICH) were reviewed. The overall mean number of months of follow-up for the entire group was 45.6 (95% CI: 42-49). Both simple linear regression and multiple regression utilizing generalized estimating equations were used to show relationships between blood pressure (BP), time and other covariates. In the simple linear regression model, the average slope of the line of systolic BP (SBP) on time for the entire group was 0.06 (95% CI: -0.09, 0.13) and the line of diastolic BP (DBP) on time was 0.01 (95% CI: -0.05, 0.07). Two multiple regression equations were fitted for the continuous response variables SBP and DBP. Covariates in the model included: time, hypertension, weight at baseline, weight, SBP baseline (SBPBL), DBP baseline (DBPBL), high vs. low dose stimulant therapy and age at starting treatment. For SBP, the covariates weight at baseline, weight and SBPBL were significant (P < 0.05) predictors. For DBP, covariates reaching statistical significance (P < 0.05) included weight and DBPBL. There was no significant change in SBP or DBP over time in either model. Two different statistical models support the conclusion that there was no significant change in SBP or DBP over time in this population.
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Affiliation(s)
- M T Wallin
- Neurology Service, VA Medical Center, Washington, DC, USA
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21
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Alóe F, Pedroso A, Tavares SM. Epworth Sleepiness Scale outcome in 616 Brazilian medical students. ARQUIVOS DE NEURO-PSIQUIATRIA 1997; 55:220-6. [PMID: 9629381 DOI: 10.1590/s0004-282x1997000200009] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The Epworth Sleepiness Scale (ESS) measures daytime sleepiness in adults. This paper reports the following data in 616 medical students: 1-ESS scores, 2-its correlation with the declared night sleep time, 3-comparison with ESS values obtained from Australia, 4-comparison of ESS values in a sub-population of 111 students tested early and late 1995. There were 387 males, 185 females and 4 not specified. Age = 20.16 +/- 2.23 (SD), ESS score = 10.00 +/- 3.69 (SD), declared sleep time = 7.04 +/- 1.03 (SD). ESS scores did not statistically correlate with sleep time. Average ESS score was statistically higher than in the Australian sample. Retesting of the medical students showed an increase in ESS values from March to November 1995. Sleep time difference was non-significant. Higher ESS scores in this sample seem to be related to shorter sleep time, but fatigue effects can not be ruled out.
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Affiliation(s)
- F Alóe
- Sleep-Wake Disorders Center (CIES) of the Faculty of Medicine, University of São Paulo General Hospital (Hospital das Clínicas), Brazil.
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22
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Abstract
Narcolepsy-cataplexy is a disabling neurological disorder that affects 1/2000 individuals. The main clinical features of narcolepsy, excessive daytime sleepiness and symptoms of abnormal REM sleep (cataplexy, sleep paralysis, hypnagogic hallucinations) are currently treated using amphetamine-like compounds or modafinil and antidepressants. Pharmacological research in the area is facilitated greatly by the existence of a canine model of the disorder. The mode of action of these compounds involves presynaptic activation of adrenergic transmission for the anticataplectic effects of antidepressant compounds and presynaptic activation of dopaminergic transmission for the EEG arousal effects of amphetamine-like stimulants. The mode of action of modafmil is still uncertain, and other neurochemical systems may offer interesting avenues for therapeutic development. Pharmacological and physiological studies using the canine model have identified primary neurochemical and neuroanatomical systems that underlie the expression of abnormal REM sleep and excessive sleepiness in narcolepsy. These involve mostly the pontine and basal forebrain cholinergic, the pontine adrenergic and the mesolimbic and mesocortical dopaminergic systems. These studies confirm a continuing need for basic research in both human and canine narcolepsy, and new treatments that act directly at the level of the primary defect in narcolepsy might be forthcoming.
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Affiliation(s)
- S Nishino
- Stanford Center for Narcolepsy, Palo Alto, CA 94304, USA
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23
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24
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Abstract
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.
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25
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Vardi J, Flechter S, Tupilsky M, Rabey JM, Carasso R, Streifler M. Kleine-Levin syndrome with periodic apnea during hypersomnic stages--E.E.G. study. J Neural Transm (Vienna) 1978; 43:121-32. [PMID: 32228 DOI: 10.1007/bf01579071] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
A 33 year old male, suffering from Kleine-Levine syndrome associated with periods of apnea during the hypersomnic attacks, is reported. Ventilatory studies negate the Pickwickian syndrome. The E.E.G.'s recorded during the hypersomnic attacks and the apneic periods showed a direct correlation between high-voltage delta waves paroxysmal E.E.G. activity, and apneic period. Medications known to improve Kleine-Levin syndrome, in our case, had no effect upon the clinical hypersomnic and apnea periods, nor on the correlatives E.E.G.'s pattern and spirometric studies. Theoretical considerations let us assume that these paroxysmal E.E.G. patterns associated with apnea are NRem-sleep serotonin dependent, and have an inhibitory influence on the respiratory centers, by alternating the equilibrium between the catecholamines and acetylcholine activities.
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Abstract
1 Plasma amphetamine and growth hormone levels have been measured in eight normal and twenty-six narcoleptic subjects following a single dose of (+)-amphetamine (20 mg) or (-)-amphetamine (20 mg) by mouth. 2 Peak plasma levels and the shape of the plasma amphetamine-time curve were similar with both isomers in normal and narcoleptic subjects. 3 In most normal subjects both (+)-and (-)-amphetamine (20 mg) caused an increase in the plasma concentration of growth hormone. The two isomers were approximately equipotent in this respect. Neither (+)- nor (-)-amphetamine (20 mg) caused an increase in plasma growth hormone concentration in narcoleptics. 4 Following amphetamine (30 mg), two of six narcoleptic subjects had an increase in plasma growth hormone concentration. 5 Levodopa (250 mg) with (-)-alpha-methyldopa hydrazine 25 mg (Sinemet) by mouth, caused a rise in plasma growth hormone concentration in most normal subjects. The magnitude of the Sinemet-induced rise in plasma growth hormone concentration in narcoleptics was less than in normal subjects.
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27
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Gillin JC, van Kammen DP, Graves J, Murphy D. Differential effects of D- and L-amphetamine on the sleep of depressed patients. Life Sci 1975; 17:1223-40. [PMID: 172755 DOI: 10.1016/0024-3205(75)90132-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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