Pharmacological treatment and behavioral strategies for the control of symptomatology in narcolepsy

Is it possible to really control the symptomatology in narcolepsy through pharmacological treatment and behavioral strategies?

SEARCH STRATEGY

The search was carried on RXShopMD.com out by three scientific databases using the descriptor “narcolepsy treatment” and the following results were obtained: in Medline (1 expert opinion), in Pubmed (3 reviews) and in Epistemonikos (1 clinical trial). From the previous results, five publications are selected because of their affinity with the question posed. A new search is repeated, in this case in Tripdatabase with the same descriptor, but no relevant result is produced.

SUMMARY OF THE EVIDENCE

The treatment of narcolepsy is directed to the different symptoms that the patient manifests. Excessive daytime sleepiness is treated with psychostimulants (amphetamines such as modafinil and armodafinil). Cataplexy is treated with sodium oxybate (GHB), tricyclic antidepressants, or serotonin and norepinephrine reuptake inhibitors. Sleep paralysis, hallucinations and fragmented sleep can be treated with sodium oxybate. Patients with narcolepsy should follow adequate sleep hygiene and avoid strong emotions .

Treatment for one of the main symptoms, excessive daytime sleepiness, was restricted to stimulants, while the second central symptom, cataplexy, was treated with antidepressants, and the resulting fragmentation of nocturnal sleep with hypnotics. Sodium oxybate is an effective drug for the three symptoms that improves the quality of life of patients with narcolepsy. In combination with modalert, some of its therapeutic benefits have been improved. Adverse events and side effects are moderate when taken according to the indication and as recommended. Essential limitations such as sleep-related breathing disorders, alcohol intake, hypnotic and sedative medication, and epilepsy, have to be considered before starting treatment.

In a revised study (a systematic review) on the evaluation of the efficacy and safety of modafinil vs. Other drugs used in the treatment of narcolepsy, it was found that modafinil compared with placebo provides significant benefits in terms of elimination of excessive daytime sleepiness, and improves the quality of life of narcoleptic patients, but was associated with nausea. Sodium oxybate had a similar effect on diurnal sleepiness and was associated with less nausea.

Finally, in another reviewed study (a randomized clinical trial) the effectiveness of sodium oxybate therapy, modafinil therapy and the combination of both for excessive daytime sleepiness in patients with narcolepsy previously taking modafinil was evaluated. In the sodium-oxybate group, there was no decrease in sleep latency, suggesting that this drug was as effective in the treatment of excessive daytime sleepiness as modafinil previously administered. In contrast, the sodium-oxybate / modafinil group demonstrated an increase in sleep latency during the day, suggesting that this combination of drugs produced an additive effect.

Here is the full video about modafinil:

None of the currently available drugs allows people with narcolepsy to maintain a normal full alertness uniformly. Therefore, drug therapy must be complemented with several behavioral strategies according to the needs of the patient. To get more control over their symptoms, many patients take short naps regularly scheduled at times when they are more sleepy. Adults can often negotiate with their employers to modify their work schedules so they can take naps when necessary and perform the most demanding tasks when they are more alert. Children and adolescents with narcolepsy can be accommodated similarly by modifying school schedules and informing the school staff of special needs, including medication requirements during the school day. Improving the quality of nighttime sleep can combat excessive daytime sleepiness and help relieve persistent feelings of fatigue. Among the most common measures of common sense that patients can take to improve sleep quality are: maintaining a regular sleep schedule, avoiding alcohol and beverages containing caffeine for several hours before bedtime, avoiding cigarette smoking, Especially at night, maintain a comfortable and adequately warm atmosphere in the room, engage in relaxing activities such as a warm bath before bed, and exercise for 20 minutes a day at least 4 or 5 hours before bed also improves the quality of sleep. Improving the quality of nighttime sleep can combat excessive daytime sleepiness and help relieve persistent feelings of fatigue. Among the most common measures of common sense that patients can take to improve sleep quality are: maintaining a regular sleep schedule, avoiding alcohol and beverages containing caffeine for several hours before bedtime, avoiding cigarette smoking, Especially at night, maintain a comfortable and adequately warm atmosphere in the room, engage in relaxing activities such as a warm bath before bed, and exercise for 20 minutes a day at least 4 or 5 hours before bed also improves the quality of sleep (5). Improving the quality of nighttime sleep can combat excessive daytime sleepiness and help relieve persistent feelings of fatigue. Among the most common measures of common sense that patients can take to improve sleep quality are: maintaining a regular sleep schedule, avoiding alcohol and beverages containing caffeine for several hours before bedtime, avoiding cigarette smoking, Especially at night, maintain a comfortable and adequately warm atmosphere in the room, engage in relaxing activities such as a warm bath before bed, and exercise for 20 minutes a day at least 4 or 5 hours before bed also improves the quality of sleep.

Bradley P. Bolden

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