Approach to a Patient with Narcolepsy
Summary
Narcolepsy is one of the most common hypersomnias of central nervous system origin. Its primary symptom is that of excessive daytime sleepiness (EDS). The clinical tetrad of narcolepsy includes EDS, cataplexy, hypnogogic hallucinations, and sleep paralysis. Fragmented nocturnal sleep is often part of the clinical syndrome as well. Sleepiness and cataplexy represent the primary sources of disability of this disorder. Treatment is focused on use of stimulants and other wake-promoting agents to promote alertness. Rapid eye movement (REM)-suppressant medications are used to suppress cataplexy and the other associated auxiliary symptoms of narcolepsy. Multimodal approach with pharmacological therapy and behavioral therapy is required to treat narcolepsy. Potential new therapies include medications that are histamine agonists to promote wakefulness and histamine antagonists for sedation. Newer therapies are being explored with the aim of replacing this deficient neurotransmitter.