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Narcolepsy update.


We wrote in the July issue about narcolepsy (excessive daytime sleepiness). Narcolepsy is a lifelong disease, but a review article in the August 9 New England Journal of Medicine notes significant advances in our understanding of this potentially dangerous disorder during the past two decades.

Although no one understand the specific process that takes place in the brain when a narcoleptic falls asleep in the middle of a conversation or while driving, or experiences cataplexy (muscular weakness brought on by emotion or excitement), it is clear that a genetic defect is responsible. In Japan, 1 in 600 has the disease; in Israel, the figure is 1 in 500,000. In the U.S., the range is from 1 in 1,000 to 1 in 10,000. Narcolepsy usually becomes apparent between ages 15 and 35, although cases younger than age 10 and older than age 50 have been seen. The onset is usually gradual, but the degree of sleepiness stabilizes after a few months. If the patient becomes increasingly sleepy after several years, another sleep disorder, such as sleep apnea, is usually the cause. Although the accompanying features (cataplexy, hallucinations and sleep paralysis) may improve with age, or even disappear in about one-third of patients, the degree of sleepiness usually persists throughout life.

Treatment of narcolepsy includes several 15- to 20-minute naps a day and the daily use of moderate doses of stimulants such as dextroamphetamine. Medication for nighttime sleep disturbances can be used occassionally--once or twice a week--but this does not appear to have any effect on daytime alertness. Although the sleepiness of narcolepsy, like normal sleeepiness, is more apt to occur in monotronous situations, such as in a classroom or lecture hall, no amount of sleep at night will alleviate the condition. Other drugs may be prescribed for cataplexy and sleep paralysis, but whatever the treatment, the patient must make considerable adjustments once this chronic disorder manifests itself.
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Publication:Medical Update
Date:Sep 1, 1990
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