Therapeutic advances in narcolepsy.
Narcolepsy treatment has changed dramatically over the last century. For the treatment of sleepiness in narcolepsy, we have progressed from the early use of caffeine. We have available a variety of different stimulants, and a wake-promoting agent, modafinil, which is widely regarded as the first-line medication for narcolepsy. Cataplexy is managed by medications whereas behavioral treatment, such as avoidance of emotion, was the only treatment available in the past. Following the widespread use of antidepressant medications for cataplexy, we now have sodium oxybate, which works by an unknown mechanism but is the only Food and Drug Administration (FDA)-approved medication for cataplexy. We also recognize that other sleep disorders can occur in narcolepsy, such as obstructive sleep apnea syndrome or rapid eye movement sleep behavior disorder, and new treatments allow these comorbid conditions to be effectively treated. However, although we cannot cure narcolepsy, the current treatments for excessive sleepiness and cataplexy can be effective for many patients. We are improving the quality of life for our patients without producing clinically significant adverse effects. We need new therapeutic advances and several medications that work, though different mechanisms are likely to be available in the near future.
Thorpy
Michael
M
Sleep-Wake Disorders Center, Montefiore Medical Center and Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY 10467, USA. thorpy@aecom.yu.edu
D001559:Benzhydryl Compounds / Q000627:therapeutic use; D002385:Cataplexy / Q000175:diagnosis / Q000188:drug therapy; D000697:Central Nervous System Stimulants / Q000627:therapeutic use*; D006801:Humans; D007167:Immunotherapy / Q000379:methods; D008774:Methylphenidate / Q000627:therapeutic use; D000077408:Modafinil; D009290:Narcolepsy / Q000175:diagnosis / Q000188:drug therapy* / Q000628:therapy; D011788:Quality of Life / Q000523:psychology; D012642:Selegiline / Q000627:therapeutic use; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*; D012978:Sodium Oxybate / Q000627:therapeutic use
D001559:Benzhydryl Compounds; D000697:Central Nervous System Stimulants; D008774:Methylphenidate; D000077408:Modafinil; D012642:Selegiline; D017367:Selective Serotonin Reuptake Inhibitors; D012978:Sodium Oxybate