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Update on treatment for idiopathic hypersomnia
Elisa Evangelista1,2, Régis Lopez1,2,3, Yves Dauvilliers1,2,3
1a Centre National de Référence Narcolepsie Hypersomnies, Unité des Troubles du Sommeil, Service de Neurologie , Hôpital Gui-de-Chauliac Montpellier , Montpellier , France.
Expert Opinion on Investigational Drugs
|December 19, 2017
Summary
Idiopathic hypersomnia (IH) is a sleep disorder causing excessive daytime sleepiness. Current treatments, like modafinil, are used off-label, highlighting the need for approved therapies and better diagnostic tools for IH management.
Area of Science:
- Neurology
- Sleep Medicine
- Pharmacology
Background:
- Idiopathic hypersomnia (IH) is a rare central disorder characterized by excessive daytime sleepiness (EDS), prolonged sleep, and sleep inertia.
- Current management of IH relies on symptomatic stimulant medications, often used long-term.
- No specific drug is currently approved worldwide for the treatment of IH.
Purpose of the Study:
- To review and summarize the available data on the pharmacological treatment of idiopathic hypersomnia.
- To assess the efficacy of various wakefulness-promoting agents in managing EDS in IH patients.
- To identify gaps in current research and suggest future directions for IH treatment.
Main Methods:
- A comprehensive literature search was conducted using Medline/PubMed/Web of Science and ClinicalTrials.gov.
- Data from 1997 to 2017 were reviewed, focusing on observational studies, case series, and clinical trials.
- Efficacy of medications was evaluated based on reported outcomes for EDS, prolonged sleep, and sleep inertia.
Main Results:
- Modafinil demonstrated efficacy in improving EDS in IH through two randomized, double-blind, placebo-controlled trials.
- Other wakefulness-promoting agents used for narcolepsy showed similar efficacy in case series of IH patients.
- Pitolisant and sodium oxybate showed promising results in retrospective studies, while the role of GABA-A receptor antagonists requires further clarification.
Conclusions:
- Most medications for EDS in IH are used off-label, emphasizing the need for approved treatments.
- Objective tests and specific clinical instruments are crucial for accurately assessing IH severity and treatment response.
- Further research is needed to optimize the management of IH, including evaluating novel therapeutic agents and diagnostic tools.
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