Stephen N. Brooks

Novel therapies for narcolepsy

Narcolepsy is a primary neurological disorder, which often produces disabling symptoms, including excessive daytime sleepiness and cataplexy. Although the precise aetiology of narcolepsy has not been determined, our understanding of the pathophysiology of this complex disorder has grown dramatically during the past several years, especially as it relates to the newly discovered hypocretin system. While symptomatic treatment of narcolepsy is available, the commonly used pharmacological agents are often not completely effective and may be poorly tolerated. The need for new therapeutic tools is, therefore, apparent. This paper explores some exciting new approaches to the treatment of narcolepsy. It is important to emphasise that, although narcolepsy is not a common disorder, new agents for its treatment will undoubtedly find more extensive use in other conditions.

Chapter 14 The syndromes of excessive daytime somnolence (excluding narcolepsy and sleep-related breathing disorders)

Publisher Summary This chapter discusses the syndromes of excessive daytime somnolence (excluding narcolepsy and sleep-related breathing disorders). Somnolence (or the synonymous terms “sleepiness” or “drowsiness”) may be defined in several ways. Some definitions of sleepiness are “a manifestation of a physiological drive for sleep (having) objective and subjective components,” and “the subjective feeling state of sleep need.” Broughton has suggested that, in fact, there may be three types of sleepiness: NREM sleepiness, REM sleepiness, and de-arousal sleepiness, respectively arising from NREM sleep pressure, REM sleep pressure, and impaired reticulocortical waking processes. While the state of somnolence may be defined along subjective or behavioral lines, it may also be characterized by several associated physiologic changes. Breathing slows and becomes more regular, and the heart rate, blood pressure, and core body temperature tend to decrease; there is a trend toward decreased sympathetic and increased parasympathetic activity, and saccadic eye movements decrease as slow eye movements increase.

New insights into the pathogenesis and treatment of narcolepsy.

Narcolepsy is a complex neurologic disorder, which has significant negative impacts on the lives of those who have it. Although the disorder is treatable, traditional methods do not alleviate symptoms completely and often produce unwanted side effects. Fortunately, recent advances in the understanding of narcolepsy offer the promise of improved treatments in the foreseeable future.