Modern treatment of narcolepsy

Abstract

Treatment for narcolepsy with and without cataplexy has changed in the last few years due to the availability of new drugs. This article recounts the clinical symptoms, pathophysiology, genetics and current diagnostic criteria as stated in the International Classification of Sleep Disorders (ICSD-2) by the American Academy of Sleep Medicine in 2005 and presents current therapeutic options based on the European and German guidelines. Since sodium oxybate and modafinil are available now, recommendations regarding the symptomatic treatment have changed and the former first-line drugs are now second choice. Recommended treatment for excessive daytime sleepiness as a major symptom of narcolepsy with or without cataplexy consists of modafinil, methylphenidate and sodium oxybate; the formerly recommended amphetamines and selegiline are now second choice. European treatment recommendations for cataplexy now list sodium oxybate as first choice and antidepressants, particularly clomipramine, and selegiline as second choice drugs. Disturbed night time sleep can also be treated with sodium oxybate, thus adding this new drug to the list of hypnotics that used to be the best option for all narcolepsy symptoms.