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Management of Narcolepsy.

Lucie Barateau^1,2,3, Régis Lopez^1,2,3, Yves Dauvilliers^4,5,6

¹Sleep-Wake Disorders Center, Department of Neurology, Hôpital Gui-de-Chauliac, CHU Montpellier, Montpellier, France.

Current Treatment Options in Neurology

|August 24, 2016

Summary

Narcolepsy type 1 and type 2 are rare sleep disorders. Current guidelines suggest similar treatments for both, focusing on excessive daytime sleepiness and sleep disturbances, with individualized risk-benefit assessments.

Keywords:

Cataplexy Hypocretin/orexin Narcolepsy type 1 Narcolepsy type 2 Sleepiness Stimulant

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Area of Science:

Neurology
Sleep Medicine

Background:

Narcolepsy type 1 (NT1) and narcolepsy type 2 (NT2) are rare central disorders of hypersomnolence.
NT1 pathophysiology involves hypocretin (Hcrt) neuron destruction, likely autoimmune; NT2 etiology is less understood.
Both share excessive daytime sleepiness (EDS) and REM sleep dysregulation, but NT2 lacks cataplexy.

Purpose of the Study:

To provide management recommendations for NT1 and NT2.
To suggest treatment strategies for excessive daytime sleepiness and cataplexy.
To highlight the need for tools to monitor treatment efficacy in narcolepsy.

Main Methods:

Review of current management strategies for narcolepsy.
Analysis of pharmacological options for excessive daytime sleepiness and cataplexy.
Expert opinion on treatment guidelines for NT1 and NT2.

Main Results:

Recommends similar medication guidelines for NT2 as NT1 (excluding cataplexy), with regular benefit-risk reassessment.
Suggests stimulants (modafinil, armodafinil) or sodium oxybate as first-line for EDS.
Recommends sodium oxybate or venlafaxine for cataplexy in NT1, with cautious initiation of anticataplectic treatment.

Conclusions:

Current treatment strategies for NT1 can be adapted for NT2, emphasizing individualized care.
Future treatments may include hypocretin (Hcrt) replacement or immune-based therapies for NT1.