Diagnosis is by the presence of appropriate clinical symptoms and confirmation by a polysomnogram followed by a multiple sleep latency test. It is currently believed to be caused by a deficiency in hypocretin-producing neurons in the lateral hypothalamus. There are nonpharmacologic (eg, scheduled naps, following proper sleep hygiene) and symptom-directed pharmacologic (eg, central nervous system stimulants, modafinil, sodium oxybate, certain antidepressants) treatments that are usually used together for optimal management of narcolepsy.ĪB - Narcolepsy is characterized by excessive daytime sleepiness, cataplexy, sleep paralysis, and hypnagogic/hypnapompic hallucinations. N2 - Narcolepsy is characterized by excessive daytime sleepiness, cataplexy, sleep paralysis, and hypnagogic/hypnapompic hallucinations. Coase warned, “If you torture the data long enough, it will confess.T1 - Clinical features, diagnosis and treatment of narcolepsyĬopyright 2010 Elsevier B.V., All rights reserved. Coincidentally (although as skeptics, we do not believe in coincidence), the initial statistical team was changed when data were sold to the French pharmaceutical company applying for the marketing authorization in France. Although he cited us,3 he overlooked the evidence we provided indicating that the Bacloville article4 was published without acknowledging major changes to the initial protocol, affecting the primary outcome. Second, Dr Andrade should have warned readers that Bacloville’s results are most questionable, lacking robustness. To the Editor: Dr Andrade’s analysis of the Bacloville trial in a recent Clinical and Practical Psychopharmacology column, in which he concluded that “individualized treatment with high-dose baclofen (30-300 mg/d) may be a useful second-line approach in heavy drinkers” and that “baclofen may be particularly useful in patients with liver disease,” deserves comment.1įirst, Andrade failed to recall that the first pivotal trial of baclofen, ALPADIR (NCT01738282 320 patients, as with Bacloville), was negative (see Braillon et al2). © Copyright 2020 Physicians Postgraduate Press, Inc.īaclofen, a French Exception, Seriously Harms Alcohol Use Disorder Patients Without Benefit Treating EDS in patients with narcolepsy. Research suggests a causative role for hypocretin deficiency in narcolepsy, and treatments ameliorating this deficiency are needed.įrom the Series: Recognizing and Treating Excessive Daytime Sleepiness in Patients with Narcolepsy Clinicians must monitor EDS during ongoing treatment so that residual symptoms can be addressed with adjustment to the regimen. Nonpharmacologic strategies should also be discussed with patients to provide optimal narcolepsy management. Some interventions also show efficacy in cataplexy. Fortunately, existing pharmacologic interventions are effective in reducing EDS for many patients, but elimination of EDS for most patients has not been achieved. The second major symptom, cataplexy, is present only in a subgroup of patients with narcolepsy. The Primary Care Companion for CNS DisordersĮxcessive daytime sleepiness (EDS) is a hallmark symptom of narcolepsy. For more CME activities, visit .įind more articles on this and other psychiatry and CNS topics:
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