Narcolepsy Clinical Trials

Narcolepsy is a condition which causes an irregular pattern of sleep caused due to an excess amount of sleep during daytime. It could be caused to autoimmune disorders, family history or brain injuries [4]. Around 0.05% of the people in the US suffer from this disorder. It has also been reported that 1 out of 2000 people in the world suffer from narcolepsy [2].

Narcolepsy can be categorized into type 1 (associated with cataplexy) and type 2 (associated without cataplexy) [1]. Cataplexy is a condition in which there is a loss of voluntary muscle control due to strong emotions of laughter, sadness or stress which results in a sudden physical collapse.

Several pieces of research in the past have found a relationship between the occurrence of narcolepsy and the loss of orexin-producing neurons. Orexin is a type of neuropeptide that is responsible for maintaining transitions between sleep and consciousness. However, the exact mechanism through which narcolepsy occurs due to the loss of neurons is still unknown.

Orexin neurons also play a significant role in the process of metabolism, feeding as well as an autonomic tone that can result in additional symptoms associated with narcolepsy [1]. However, the exact mechanism through which narcolepsy occurs due to the loss of neurons is still quite a mystery to be solved by the researchers.

The symptoms associated with narcolepsy could have a significant effect on the personal as well as the professional life of the affected individuals. Sleepiness during the daytime could result in the failure of concentration, decrease the working potential as well as affect the ambition of a person. Disturbed sleeping patterns could also result in a number of mental health-related issues. Therefore, proper control, as well as management of symptoms related to narcolepsy with the help of conducting clinical trials, become quite significant.

Excessive Daytime Sleep (EDS) could result in sleep paralysis and a decrease in the quality of sleep caused due to its fragmentation during the night time. Sleep paralysis is a condition in which an affected individual is unable to control the voluntary muscles during the sleep-wake interface [2]. Rare cases of hallucinations are seen in patients affected by narcolepsy.

Medications

Drug stimulants such as amphetamines, dextroamphetamine and methylphenidate, wakefulness-promoting agents could be used to manage excessive daytime sleep (EDS) as well as sleep attacks by improving alertness in patients. This is done by targeting neurotransmitters such as dopamine and norepinephrine. Sodium oxybate can manage EDS as well as the symptoms of disturbed night sleep. Benzodiazepines and hypnotic non-benzodiazepines, anti-depressants could also be used for the control of symptoms caused due to narcolepsy [2]. Medical experts select medications based on experience, guidelines, patient's history as well as personal preferences.

Managing Behavioral Patterns

Education: It is quite important to create an awareness amongst the patients dealing with narcolepsy regarding the nature and impact of symptoms associated with it. Apart from that, it is also quite significant to spread knowledge about the strategies and medications regarding the control of it [2].

Improving Sleep Hygiene: A significant effort should be made to improve the different habits that can help a person get proper sleep during the night. Improving the quality of sleep and creating perfect sleep hygiene could be achieved by avoiding alcohol, caffeine, smoking, consuming heavy meals before going to bed. Apart from that, an optimal environment free of unwanted noise as well as conducive temperature could also help one to attain sleep hygiene required for the management of narcolepsy [2].

Strategic Napping: Small naps ranging from 15 to 20 minutes for twice during daytime could result in an improved pattern of sleep. It should be noted that these naps should not last more than 30 minutes as it could result in an increase in drowsiness [2].

A sleep log can be used in order to track the sleeping habits of a patient which could help medical experts apply different methods of diagnostics as well as treatment. Polysomnogram (PSG) is the monitoring of brain and muscle activities during the night which could help one to study a sleep cycle effectively. This includes monitoring of eye movements as well as breathing in order to get a clear picture of the quality of sleep of an individual during the night time. Multiple sleep latency tests (MSLT) are another method used to diagnose narcolepsy which measures the ability of an individual to fall asleep during day time and the frequency of intervals during night sleep [4].

Techniques for transplantation of cells from the hypothalamus region of the brain could be used to control the desire for excessive sleep during the daytime. Replacement of peptides present in orexin could result in a more effective version of it that could result in the reversal of symptoms caused due to narcolepsy. Gene replacement therapy as well as immunotherapy could also find a great application in the management of its symptoms in future [3]. There are a number of future treatments being investigated for the treatment of narcolepsy with current and future clinical trials that should be taken note of by people looking for increased treatment options.

REFERENCES

Narcolepsy is a long-term neurological disorder that involves a decreased ability to regulate sleep-wake cycles. Symptoms include periods of excessive daytime sleepiness that usually last from seconds to minutes and may occur at any time. About 70% of those affected also experience episodes of sudden loss of muscle strength, known as cataplexy. These experiences can be brought on by strong emotions. Less commonly there may be inability to move or vivid hallucinations while falling asleep or waking up. People with narcolepsy tend to sleep about the same number of hours per day as people without, but the quality of sleep tends to be worse.

The exact cause of narcolepsy is unknown with potentially several causes. In up to 10% of cases there is a family history of the disorder. Often those affected have low levels of the neuropeptide orexin which may be due to an autoimmune disorder. Trauma, infections, toxins, or psychological stress may also play a role. Diagnosis is typically based on the symptoms and sleep studies, after ruling out other potential causes. Excessive daytime sleepiness can also be caused by other sleep disorders such as sleep apnea, major depressive disorder, anemia, heart failure, drinking alcohol, and not getting enough sleep. Cataplexy may be mistaken for seizures.

While there is no cure, a number of lifestyle changes and medications may help. Lifestyle changes include taking regular short naps and sleep hygiene. Medications used include modafinil, sodium oxybate, and methylphenidate. While initially effective, tolerance to the benefits may develop over time. Tricyclic antidepressants and selective serotonin reuptake inhibitors (SSRIs) may improve cataplexy.

About 0.2 to 600 per 100,000 people are affected. The condition often begins in childhood. Men and women are affected equally. Untreated narcolepsy increases the risk of motor vehicle collisions and falls. The term narcolepsy is from the French narcolepsie. The French term was first used in 1880 by Jean-Baptiste-Édouard Gélineau who used the Greek νάρκη (narkē) meaning "numbness" and λῆψις (lepsis) meaning "attack".

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