Overview of management of narcolepsy

Abstract

Narcolepsy is a chronic sleep disorder that is characterized by excessive daytime sleepiness, cataplexy, hypnagogic hallucinations, and sleep paralysis. Since these symptoms are often disabling, most patients need lifelong treatments. Non-pharmacological treatments (i.e., behavioral modification) are often helpful for the clinical management of narcoleptic patients. However, over 90% of diagnosed narcoleptic patients are reported to take medications to control their symptoms. Traditionally, the amphetamine-like CNS stimulants have been used for clinical management to improve EDS, and trycyclic antidepressants as anticataplectics, but the treatment has evolved recently with new and better-tolerated compounds such as modafinil (and its r-enantiomer, armodafinil) for EDS and adrenergic/serotonergic selective reuptake inhibitors as anticataplectics. Nighttime administration of a short-acting sedative, gamma-hydroxybutyrate (sodium oxybate in the USA) has also been used for the treatment for EDS and cataplexy. Since a large majority of human narcolepsy patients are hypocretin peptide-deficient, hypocretin replacement therapy may also be a new therapeutic option, but this is still not available for human patients. If hypocretin replacement is effective in hypocretin-deficient narcolepsy, cell transplantation and/or gene therapy may be developed in the near future. In this review, we first describe clinical symptoms of narcolepsy, and then the state-of-the-art knowledge about both pharmacological and non-pharmacological treatments of narcolepsy. © 2010 Springer-Verlag New York.