Narcolepsy: Latest Medical Breakthroughs

Wednesday, 06 Oct 2010 01:52 PM

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Each year, approximately one person in every two thousand in the U.S. is affected with narcolepsy, a chronic and commonly diagnosed sleep disorder. Narcolepsy is characterized by the body’s inability to regulate sleep.

Cataplexy narcolepsy results in involuntary loss of muscle control.
In the late 1990s, the research conducted by Mignot and others showed that the disease stems from a lack of hypocretin, a hormone that promotes wakefulness. It was established that people with sleep narcolepsy don’t possess the brain cells which produce hypocretin. This finding helped understand the reasons behind uncontrollable episodes of sleepiness. Mignot and others believe that the body's immune system plays a role in killing hypocretin-making cells.

Scientific literature shows a link between narcolepsy and a variant for the human leukocyte antigen, or HLA, gene. The immune system uses HLAs to differentiate between "self" cells and foreign cells. Most autoimmune diseases are associated with variants of HLA. In recent studies, more than 90 percent of narcolepsy patients were shown to carry one such variant.
 
Preliminary findings with voxel-based morphometry, conducted by Christian Kaufmann and colleagues during narcolepsy research, have revealed reduced cortical gray matter in people with narcolepsy. A selective loss of hypocretin/orexin-containing hypothalamicneurons in patients with narcolepsy has been established. The researchers compared MRI-derived gray matter maps of 12 patients with narcolepsy. Bilateral reductions in cortical gray matter were observed in patients with narcolepsy.
 
Scientists involved with research on cataplexy narcolepsy are trying to enhance understanding of the possible causes of narcolepsy. The research findings and developments would help find suitable narcolepsy treatment.

Relatively recent narcolepsy research identifies narcolepsy as a genetically based sleep regulation disorder. At the same time, head trauma and brain injury have been documented to be the reasons in some forms of narcolepsy, as suggested in some sleep narcolepsy research findings.
 
In 1999, the FDA approved a new non-amphetamine wake-promoting drug called modafinil for the treatment of EDS. In clinical trials, modafinil proved to be effective in alleviating EDS while producing fewer, less serious side effects than amphetamines. Headache is the most commonly reported adverse effect.
 
Scientists are studying narcolepsy patients and their families looking for clues to the causes, course, and hoping to find an effective treatment for narcolepsy. On July 17, 2002, the FDA approved Xyrem (sodium oxybate or gamma hydroxybutyrate, also known as GHB) for treating people with narcolepsy who experience episodes of cataplexy.  Due to the safety concerns associated with the use of this drug, the distribution of Xyrem is tightly restricted.
 
Modafinil and other stimulants are used for treating mild narcolepsy, but M. Thorpy in Therapeutic Advances in Narcolepsy explained that they were not often effective for treating cataplexy narcolepsy. The study showsthat antidepressants (TCAs) like Protriptyline, Desipramine, and Imipramine may be effective. It follows that other antidepressants may prove useful as well.
 
Recent developments have addressed the role of sleep hygiene and daytime naps. New pharmacological options are available for treating narcolepsy that may have fewer side effects and greater efficacy in comparison to the older options. New safer approaches are being explored for better resolution of sleep narcolepsy.

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