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Emerging treatments options for narcolepsy throughout a case

Published online by Cambridge University Press:  23 March 2020

L. Gallardo Borge
Affiliation:
HCU Valladolid, Psychiatry, Valladolid, Spain
H. de la Red Gallego
Affiliation:
HCU Valladolid, Psychiatry, Valladolid, Spain
A. Alonso Sánchez
Affiliation:
HCU Valladolid, Psychiatry, Valladolid, Spain
S. Gómez Sánchez
Affiliation:
HCU Valladolid, Psychiatry, Valladolid, Spain
C. Noval Canga
Affiliation:
HCU Valladolid, Psychiatry, Valladolid, Spain
E. Mayor Toranzo
Affiliation:
HCU Valladolid, Psychiatry, Valladolid, Spain
S. Cepedello Pérez
Affiliation:
HCU Valladolid, Psychiatry, Valladolid, Spain
L. Rodriguez Andrés
Affiliation:
HCU Valladolid, Psychiatry, Valladolid, Spain
T. Ballesta Casanova
Affiliation:
HCU Valladolid, Psychiatry, Valladolid, Spain

Abstract

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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.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Type
EV1230
Copyright
Copyright © European Psychiatric Association 2016

References

Further reading

Gbolaga, A, Rickards, H Narcolepsy: a review. Neuropsychiatr Dis Treat 2011;7:507–18.Google Scholar
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