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- Title
Emerging treatments options for narcolepsy throughout a case.
- Authors
Alvarez Astorga, A.; Gallardo Borge, L.; de la Red Gallego, H.; Alonso Sánchez, A.; Gómez Sánchez, S.; Noval Canga, C.; Mayor Toranzo, E.; Cepedello Pérez, S.; Rodriguez Andrés, L.; Ballesta Casanova, T.
- Abstract
Background Narcolepsy is a neurological disorder characterized by disturbances in REM sleep. The symptoms that the patient could present are excessive daytime sleepiness, cataplexy, sleep paralysis, hypnagogic hallucinations and disrupted nocturnal sleep. Its etiology is unknown. Currently, there is established pharmacotherapy for symptomatic treatment, which are often unsatisfactory. Objective Review of new treatments for narcolepsy based on recent advances about its ethiopathogenesis. Method Seventy-five year-old female with a personal history of arterial hypertension and obstructive sleep apnea syndrome. The patient presented several episodes of abrupt muscular weakness, nightmares, sleep paralysis and excessive daytime sleepiness. Diagnosed of narcolepsy and treated with methylphenidate immediate-release (IR) 10 mg, alprazolam 1 mg, and trazodone 100 mg with good response. Results Due to persistent symptoms, treatment was modified to osmotic-release oral system (OROS) – methylphenidate resulting on a substantial weight loss (12 kg) and persistence of symptoms. Another methylphenidate preparations were unsuccessfully tested. Currently she continues treatment based on methylphenidate release-release and she improved significantly though she sometimes presented daytime sleepiness. Discussion Recent studies have shown that a loss of the hypothalamic neuropeptide hypocretin causes Narcolepsy with cataplexy and that an autoimmune mechanism may be responsible for this loss (related to HLA DQB*0602). Pathophysiology of narcolepsy without cataplexy is less understood. Although amphetamines and its derivatives are the mainstay of management, therapies that involve hypocretine seems to be hopeful (intranasal, peripherical or hipocretin cell transplantation). Monotherapy with GHB, H3 antagonist receptors, TRH analogs and immunotherapy are also being studied.
- Subjects
NARCOLEPSY; METHYLPHENIDATE; ILLUSION (Philosophy); IMMUNOTHERAPY; SLEEP paralysis; NEUROPEPTIDES; THERAPEUTICS
- Publication
European Psychiatry, 2016, Vol 33, pS741
- ISSN
0924-9338
- Publication type
Article
- DOI
10.1016/j.eurpsy.2016.01.2215