Treatment of patients with narcolepsy

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In Slovenia, the only registered medicine for all the major symptoms of narcolepsy in adult patients with cataplexy has been available since 2007.

A personal doctor who makes a diagnosis suspecting narcolepsy in a patient will send the patient for examination to a sleep disorder clinic.

Neurologist specialist for sleep disorders (somnologists) asks the patient about the main symptoms of narcolepsy. The diagnosis of narcolepsy must be confirmed by a night polysomnography, followed by the mean sleep latency test. Patients are usually admitted to hospital (2 days) for a short time and during this period a night and day polygraphic sleep recording is made in the sleep disorder laboratory.

Of course, the patient should always be clinically examined (basic otorhinolaryngological and neurological examination). There is also the possibility of secondary narcolepsy (narcolepsy due to some other cause in the brain), which can be ruled out by image brain diagnostics (CT, MRI of the head). Excessive daily sleepiness should also be ruled out due to other sleep disorders, other illnesses, taking medication or drug abuse.

Polysomnography

Polysomnography is an objective method for monitoring the sleeping subject in a laboratory. The subject sleeps in the room and in the next room he/she is continuously monitored by a neurophysiological assistant who records several physiological activities during sleep:

  • brain activity (electroencephalography – EEG)
  • movement of eye eyeballs (electrooculography – EOG)
  • muscular activity (electromyography – EMG)

During sleep, breathing, heart beat and blood oxygen saturation of patients are also monitored as well.

Mean sleep latency test

In patients with narcolepsy, besides full-time sleep recording, mean sleep latency tests (MSLT) should be used to measure daytime sleepiness and to confirm or disconfirm the subjective excessive sleepiness due to further targeted therapy. Patients with narcolepsy are inclined to fall asleep very quickly.

The test is always performed after a night of sleep in a somnological laboratory. The subject goes to bed five times a day (every two hours) and gets instructions to calm down and try to fall asleep. The time to sleep (the time from the turning off of the light to the sleep) is measured and the mean latency of all five tests is calculated.

Treatment of a patient with narcolepsy

Patients can take care of a few things by themselves, with adequate sleep hygiene and sleep planning throughout the day, which will reduce the occurrence of unpredictable sleep attacks throughout the day.

In the past, various drugs, especially psychostimulants (stimulants), were used to treat excessive daytime sleepiness and various antidepressants were used to treat REM (cataplexy, hallucination, paralysis), which reduced the possibility of direct sleep into REM sleep.

In Slovenia, the only registered medicine for all the major symptoms of narcolepsy in adult patients with cataplexy has been available since 2007.

At the beginning of treatment, the patient should visit the doctor every two weeks until they together determine the dose that is most suitable for the patient. Later it is sufficient if the patient visits the doctor at least once every three months.

A regular visit to the doctor is very important for a safe continuation of treatment with the medicine.