Narcolepsy
Bassetti C.
Neurology Department,
University Hospital (Inselspital),
3010 Bern, Switzerland.
Curr Treat Options Neurol 1999 Sep;1(4):291-298
ABSTRACT
Narcolepsy is a disabling, chronic
sleep-wake disorder that typically starts in a patient's second or third
decade of life. Its key features are hypersomnia and cataplexy. Sleep
paralysis, hallucinations, and disrupted sleep are nonspecific symptoms and
are not always present. Disability relates primarily to sleepiness- related
cognitive impairment, accidents, and psychosocial problems. Treatment,
which includes counseling, scheduled napping, and pharmacologic intervention,
is effective for most patients. Hypersomnia is best treated with such
indirect sympathomimetics as mazindol, pemoline, methylphenidate, and
amphetamine. Modafinil may become the drug of choice because it has
fewer side effects. Cataplexy, sleep paralysis, and hallucinations may be
ameliorated by compounds, including clomipramine and imipramine, that suppress
rapid eye movement (REM) sleep. Regular follow-up visits enable the
clinician to recognize uncommon but serious side effects (tolerance, substance
abuse, psychosis, and hypertension) and additional sleep disturbances (sleep
apnea, periodic limb movements in sleep, REM sleep behavior disorder), which
can be specifically treated.
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