![]() 5 Lack of sleep and/or inability to maintain wakefulness leads to reduced quality of life and a potentially unsafe working environment with public safety risks. ![]() 5 Prescription and over-the-counter medications that can cause EDS includes beta-blockers, sedative/hypnotics, anticonvulsants, and opioids. 5 A common cause of EDS is insufficient sleep however, EDS is also a symptom and manifestation of medical disorders (narcolepsy, obstructive sleep apnea (OSA), restless leg syndrome, major depressive disorder, stroke, Parkinson’s disease, traumatic brain injury, neurologic lesion, and bipolar disorder). 1,2 EDS is defined as unintentional sleepiness, or the inability to maintain desired wakefulness, which affects one’s functional ability. 2,4 NT1 and NT2 share a clinical profile however, patients with NT1classically present with cataplexy, sudden paralysis of muscle tone triggered by strong emotions such as laughing. 2 NT1 is caused by an extensive loss of hypothalamic neurons that produce hypocretin 1 and 2, which are neuropeptides responsible for regulating sleepiness and wakefulness. 1,3 The International Classification of Sleep Disorder (ICSD) has categorized narcolepsy into two subtypes: Narcolepsy Type 1 (NT1) and Narcolepsy Type 2 (NT2). 2 Common causes of delayed and incorrect diagnoses include lack of physician familiarity with narcolepsy symptoms and comorbidities that mask narcolepsy symptoms. 1 The onset of narcolepsy is in adolescence or early adulthood however, diagnosis is usually delayed by 8-12 years. 1 It is estimated that 1 in every 2000 individuals is affected by narcolepsy, and about half are undiagnosed. Narcolepsy is a disabling neurological disorder characterized by excessive daytime sleepiness (EDS) and disturbed nighttime sleep. In summary, based on comparative studies, recent evidence has shown that Pitolisant is non-inferior to Modafinil in the treatment of EDS but superior to Modafinil in reducing cataplexy. Recent phase II and III trials have shown that Pitolisant helps reduce the ESS score and cataplexy. ![]() It is a novel drug approved in August 2019 by the FDA, is not classified as a controlled substance, and is approved for use in Europe and the United States to treat EDS and cataplexy in narcolepsy. Pitolisant is a histamine-3 receptor (H3R), competitive antagonist, and inverse agonist, acting through the histamine system to regulate wakefulness. This review discusses the epidemiology, pathophysiology, risk factors, presentation, treatment of narcolepsy, and the role of a novel drug, Pitolisant, in the treatment of EDS in adults with narcolepsy. Current pharmacologic therapies include Modafinil and Armodafinil for EDS and sodium oxybate for cataplexy. Common causes of delayed and incorrect diagnoses of these conditions include lack of physician familiarity with narcolepsy symptoms and comorbidities which mask narcolepsy signs and symptoms. It is also associated with many other disorders, including psychiatric disorders, neurologic illnesses, and medication side effects. Sleep paralysis and hypnagogic hallucinations can occur in people without narcolepsy.Narcolepsy is a debilitating sleep disorder that presents with excessive daytime sleepiness (EDS) and cataplexy, which is a sudden paralysis of muscle tone triggered by strong emotions such as laughing. The patient experiences these dreams as reality, and these may be particularly vivid and frightening.Īutomatic behaviour occurs when familiar routines or boring tasks are performed with no recollection or memory of them later. Hypnagogic hallucinations are very vivid, scary dreams and sounds, which the patient experiences when semi-awake and beginning to dream. Sleep paralysis refers to episodes when the patient is unable to talk or move for brief periods upon falling asleep or waking up. It is less common than EDS, and can cause a range of physical changes from slurred speech to total physical collapse, lasting from a few seconds to a few minutes. The condition is troublesome and occasionally results in embarrassing situations.Ĭataplexy is a loss of muscle control triggered by strenuous exercise or intense emotions such as laughter, anger and joy. It presents as frequent drowsiness and inability to stay awake during the day, even after getting enough sleep at night. Excessive daytime sleepiness (EDS) is the most important and usually the first symptom.
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