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What
treatments are available?
Narcolepsy cannot yet be cured. But EDS
and cataplexy, the most disabling symptoms
of the disorder, can be controlled in
most patients with drug treatment. Often
the treatment regimen is modified as symptoms
change.
For decades, doctors have used central
nervous system stimulants-amphetamines
such as methylphenidate, dextroamphetamine,
methamphetamine, and pemoline-to alleviate
EDS and reduce the incidence of sleep
attacks. For most patients these medications
are generally quite effective at reducing
daytime drowsiness and improving levels
of alertness. However, they are associated
with a wide array of undesirable side
effects so their use must be carefully
monitored. Common side effects include
irritability and nervousness, shakiness,
disturbances in heart rhythm, stomach
upset, nighttime sleep disruption, and
anorexia. Patients may also develop tolerance
with long-term use, leading to the need
for increased dosages to maintain effectiveness.
In addition, doctors should be careful
when prescribing these drugs and patients
should be careful using them because the
potential for abuse is high with any amphetamine.
In 1999, the American Drugs Authority
approved a new non-amphetamine wake-promoting
drug called modafinil for the treatment
of EDS. Interestingly, modafanil has been
used in France since 1994. In clinical
trials, modafinil does not appear to lead
to tolerance.
Two classes of anti-depressant drugs have
proved effective in controlling cataplexy
in many patients: tricyclics in general,
antidepressants produce fewer adverse
effects than do amphetamines. Other anti-depressants,
such as Venlaflaxine, are very helpful.
On July 17th, 2002, the American Drugs
Authority approved Xyrem (sodium oxybate
or gamma hydroxybutyrate, also known as
GHB) for treating people with narcolepsy
who experience episodes of cataplexy.
It can also be prescribed when nocturnal
sleep is very disturbed. Due to safety
concerns associated with the use of this
drug, the distribution of Xyrem is tightly
restricted. Xyrem cannot be mixed with
alcohol.
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