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Cataplexy treatment drugs6/4/2023 ![]() ![]() A compromised hypocretin/orexin signaling obviously plays one of the most important roles in the pathophysiology of cataplexy but compounds targeting specifically to hypocretin/orexin receptors are lacking so far. The treatment response varies between patients and reflects its complex and difficult interaction between the different brain-networks involved in the narcolepsy-cataplexy complex. Till today, the treatment of cataplexy in the context of narcolepsy is a symptomatic therapy. ![]() Around the same time with the discovery of tricyclic antidepressants, the combined therapy for narcolepsy with cataplexy consisting of stimulants against sleepiness and the antidepressant imipramine against cataplexy was established. In this first description, they also introduce methylphenidate as a possible treatment for daytime sleepiness. The “narcoleptic tetrade” as described by the authors refers to the four-element symptom constellation: daytime sleepiness, cataplexy, sleep paralysis, and hypnagogic hallucinations. The finding of an association between excessive daytime sleepiness and the occurrence of emotion-triggered cataplexies was an important step in the understanding of narcolepsy. An interesting neurophysiological study confirmed a reduction of the size of the H reflex in normal people when laughing. Emotionally triggered muscle weakness has even made it into a famous Beatles song (“Honey Pie,” White Album, 1968) reflecting its popularity in the normal population. A “weak in the knees” in situations of high emotional intensity may be experienced in healthy people, probably representing a physiological minor expression of cataplexy. In the beginning of the twentieth century, episodes of muscle weakness caused by emotions were first described and named cataplexy, which is a term from the Greek and consists of the terms kata = down and plessein = beat. New therapeutic actions either targeting the autoimmune mechanisms underlying orexin cell death or substituting orexin action are promising treatments for the near future. Treatment for cataplexy still remains symptomatic but new agents with better tolerability and usability are continuously developed. SummaryĬataplexies still remain an under-recognized phenomenon due to missing diagnostic measures. Abrupt cessation of anticataplectic medication especially antidepressants increase the risk of status cataplecticus, a virtually continuous series of long-lasting cataplectic attacks. In the recent years, with the development of new anticataplectic agents (e.g., Pitolisant) symptomatic treatment of cataplexy has further improved. With the discovery of hypocretin/orexin, the understanding of the pathophysiology of cataplexy advanced in the past decades. This review gives an overview of the current understanding of cataplexy and its available treatment options. If you’d like to know more, contact us now.Cataplexy, an involuntary loss of muscle activity triggered by strong emotions is the most impressive symptom in narcolepsy. We have experience in those medications used for Narcolepsy and Narcolepsy-like conditions. There are other medications available overseas including Pitolisant and Solriamfetol, these are not available in Australia at present.Īt Adelaide Sleep, we routinely counsel, diagnose, and treat all aspects of Narcolepsy and Idiopathic Hypersomnia. We provide regular clinical monitoring in conjunction with patients’ General Practitioners, to ensure optimal titration of treatment modalities based on the patient’s clinical status. Careful consideration needs to be made for selecting those who should be on Xyrem, and the potential side effects from Xyrem. Accessing Xyrem involves several steps including involving state and federal bodies overseeing the prescribing of this. Sodium oxybate (Xyrem, sodium salt of gamma-hydroxybutyrate) has been used in the USA since 2002, and has been used by our clinic since Australian access was granted in 2015. These still however require longterm vigilance. Modafinil and Armodafinil (Modavigil, Nuvigil) are generally better-tolerated than amphetamine-based medications, and with less side effects. Many medications can be used to treat Narcolepsy, each with their own pros and cons.ĬNS stimulants such as Methylphenidate (Ritalin, Concerta) and dextroamphetamine (dexamphetamine, dexamfetamine) work well but have long term implications. Adequate sleep at night is important, daytime timed-naps can be useful. Good sleep hygiene is crucial in managing Narcolepsy symptoms in the long term. ![]()
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