Psychostimulants for hypersomnia (excessive daytime sleepiness) in myotonic dystrophy.
BACKGROUND
Excessive daytime sleepiness is a common symptom of myotonic dystrophy. Psychostimulants are drugs increasingly used to treat hypersomnia in myotonic dystrophy.


OBJECTIVE
To search systematically for, and combine all evidence from, randomised trials relating to the effects of psychostimulants in myotonic dystrophy patients with hypersomnia.


METHODS
We searched the Cochrane Neuromuscular Disease Trial Register (searched May 2001) for randomised trials concerning psychostimulants in myotonic dystrophy, we searched of the bibliographies of identified papers and we contacted the authors of the papers.


METHODS
We considered all randomised or quasi randomised trials that have evaluated any type of psychostimulants (versus a placebo or no treatment) in children or adults with proven myotonic dystrophy and hypersomnia.


METHODS
Potentially relevant papers were scrutinised by two reviewers and the selection of eligible studies was agreed by them and a third reviewer. Data were extracted by one reviewer and checked by a second reviewer.


RESULTS
Primary outcome We found no trial that assessed the effect of a psychostimulant on the results of the maintenance of wakefulness tests. Secondary outcomes Only one eligible trial was found. In this crossover double blind study of 10 patients with myotonic dystrophy, the efficacy of selegiline was evaluated against a placebo on the multiple sleep latency test. There was no difference between the selegiline and placebo periods in mean improvement in the multiple sleep latency test scale.


CONCLUSIONS
There is no evidence to support the use of a psychostimulant to treat hypersomnia in myotonic dystrophy. Randomised trials are needed to evaluate the efficacy and safety of psychostimulants.
Annane
D
D
Critical Care Department, Hôpital Raymond Poincaré, Assistance Publique - Hôpitaux de Paris, 104. Boulevard Raymond Poincaré, Garches, Ile de France, France, 92380. djillali.annane@rpc.ap-hop-paris.fr
Miller
R
R
Barnes
P
P
D006970:Disorders of Excessive Somnolence / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D008996:Monoamine Oxidase Inhibitors / Q000627:therapeutic use; D009223:Myotonic Dystrophy / Q000150:complications*; D011619:Psychotropic Drugs / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D012642:Selegiline / Q000627:therapeutic use
D008996:Monoamine Oxidase Inhibitors; D011619:Psychotropic Drugs; D012642:Selegiline