Narcolepsy a neurological disorder.......

1. NARCOLEPSY
PRESENTED BY: JAWAD ALI MIAN

2. NARCOLEPSY
 NARCOLEPSY IS A NEUROLOGICAL DISORDER THAT AFFECTS THE
CONTROL OF SLEEP AND WAKEFULNESS.
 PEOPLE WITH NARCOLEPSY EXPERIENCE EXCESSIVE DAYTIME
SLEEPINESS AND INTERMITTENT, UNCONTROLLABLE EPISODES OF
FALLING ASLEEP DURING THE DAYTIME.
 IT IS NOT RELATED TO DEPRESSION, SEIZURE DISORDERS, FAINTING, OR
SIMPLE LACK OF SLEEP.
 THESE SUDDEN SLEEP ATTACKS MAY OCCUR DURING ANY TYPE OF
ACTIVITY AT ANY TIME OF THE DAY.
 IN A TYPICAL SLEEP CYCLE, WE INITIALLY ENTER THE EARLY STAGES OF
SLEEP FOLLOWED BY DEEPER SLEEP STAGES AND ULTIMATELY (AFTER
ABOUT 90 MINUTES) RAPID EYE MOVEMENT (REM) SLEEP.

3. CONT………..
 People suffering from narcolepsy, REM sleep occurs almost immediately in the
sleep cycle, as well as periodically during the waking hours.
 It is in REM sleep that we can experience dreams and muscle paralysis which
explains some of the symptoms of narcolepsy.
 Narcolepsy usually begins between the ages of 15 and 25, but it can become
apparent at any age. In many cases, narcolepsy is undiagnosed and, therefore,
untreated.
 Narcolepsy seems to be hereditary. It is believed to affect approximately 1:1000
people of both sexes and all races. It is not life-threatening; people with narcolepsy
can expect to live a normal life span.

4. EPIDIMIOLOGY OF NARCOLEPSY
 Narcolepsy is a frequent disorder it is the second leading cause of excessive
daytime sleepiness diagnosed by sleep centers after obstructive sleep apnea.
 In the United States it is estimated that this condition afflicts as many as 200,000
Americans but fewer than 50,000 are diagnosed.
 It is as widespread as Parkinson's disease or multiple sclerosis and more prevalent
than cystic fibrosis but it is less well known.
 Narcolepsy is often mistaken for depression, epilepsy, or the side effects of
medications. It can also be mistaken for poor sleeping habits, drug use, or
laziness.

5. CAUSES OF NARCOLEPSY
 The cause of narcolepsy is not known however, scientists have made progress
toward identifying genes strongly associated with the disorder.
 These genes control the production of chemicals in the brain that may signal sleep
and awake cycles. Some experts think narcolepsy may be due to a deficiency in the
production of a chemical called hypocretin by the brain.
 In addition, researchers have discovered abnormalities in various parts of the brain
involved in regulating REM sleep. These abnormalities apparently contribute to
symptom development.
 According to experts, it is likely narcolepsy involves multiple factors that interact
to cause neurological dysfunction and REM sleep disturbances.

6. PATHOPHYSIOLOGY
 Orexin, also known as hypocretin, is a neuropeptide that acts within the brain to
regulate appetite and wakefulness as well as a number of other cognitive and
physiological processes.
 While there are billions of cells in the human brain, only 10,000–20,000 neurons
secrete orexin peptides all of these neurons project out of the lateral hypothalamus.
 Loss of these orexin-producing neurons causes narcolepsy and most individuals
with narcolepsy have a reduced number of these neurons in their brains.

7. SYMTOMS OF NARCOLEPSY
Excessive daytime sleepiness
In general, EDS interferes with normal activities on a daily basis, whether or not a
person with narcolepsy has sufficient sleep at night.
People with EDS report mental cloudiness, a lack of energy and concentration,
memory lapses, a depressed mood, andor extreme exhaustion.
Cataplexy
This symptom consists of a sudden loss of muscle tone that leads to feelings
of weakness and a loss of voluntary muscle control.
It can cause symptoms ranging from slurred speech to total body collapse, depending
on the muscles involved, and is often triggered by intense emotions such as surprise,
laughter, or anger.

8. Sleep paralysis
This symptom involves the temporary inability to move or speak while falling asleep
or waking up. These episodes are generally brief, lasting a few seconds to several
minutes.
After episodes end, people rapidly recover their full capacity to move and speak.

9. DIAGNOSIS OF NARCOLEPSY
 A physical exam and exhaustive medical history are essential for proper diagnosis
of narcolepsy. However, none of the major symptoms is exclusive to narcolepsy.
 Several specialized tests, which can be performed in a sleep disorders clinic or
sleep lab, usually are required before a diagnosis can be established.
 Two tests that are considered essential in confirming a diagnosis of narcolepsy are
the polysomnogram (PSG) and the multiple sleep latency test (MSLT).
 The PSG is an overnight test that takes continuous multiple measurements while a
patient is asleep to document abnormalities in the sleep cycle.
 A PSG can help reveal whether REM sleep occurs at abnormal times in the sleep
cycle and can eliminate the possibility that an individual's symptoms result from
another condition.

10. CONT…….
The MSLT is performed during the day to measure a person's tendency to fall asleep
and to determine whether isolated elements of REM sleep intrude at inappropriate
times during the waking hours.
As part of the test, an individual is asked to take four or five short naps usually
scheduled two hours apart.

11. TYPES OF NARCOLEPSY
 Narcolepsy with cataplexy
 Narcolepsy without cataplexy

12. TREATMENT OF NARCOLEPSY
 Although there is no cure for narcolepsy, the most disabling symptoms of the
disorder (EDS and symptoms of abnormal REM sleep, such as cataplexy) can be
controlled in most people with drug treatment.
 Sleepiness is treated with amphetamine like stimulants, while the symptoms of
abnormal REM sleep are treated with antidepressant drugs.
 There has recently been a new medication approved for those who suffer from
narcolepsy with cataplexy.
 Lifestyle adjustments such as avoiding caffeine, alcohol, nicotine, and heavy
meals, regulating sleep schedules, scheduling daytime naps (10-15 minutes in
length), and establishing a normal exercise and meal schedule may also help to
reduce symptoms.

13. MEDICATIONS
Modafinil
 This stimulant is a unique chemical compound that has replaced amphetamines as
a first-line treatment for EDS.
 Modafinil is an effective, FDA approved treatment for narcolepsy with few side
effects and a low potential for abuse.

14. GHB (gamma-hydroxybutyrate)
 GHB (Xyrem) can improve alertness and also reduce cataplexy. It tends to take
about six weeks to nine weeks before it consistently reduces sleepiness.
 It is a preferred option to treat cataplexy because it has few side effects.
 Although the FDA approved Xyrem in 2002 for the treatment of cataplexy.

15. Tricyclic antidepressants
 Tricyclic antidepressants formerly were the first treatment option for cataplexy.
Severe side effects now make them a last resort.
 Other antidepressants (atomoxetine, clomipramine, fluoxetine, venlafaxine,
zimeldine) have been effective and have produced fewer side effects.
 The use of antidepressants to treat cataplexy is not approved by the FDA.

16. Amphetamines
 Amphetamines were formerly the most common treatment option for EDS in narcolepsy, but they
carry a strong risk of addiction.
 Methylphenidate, pemoline and mazindol also have been used.
 It may treat both sleepiness and cataplexy. Relatively few side effects have been reported with its
use.

17. LIFESTYLE ADJUSTMENT THAT CAN HELP TO COPE WITH NARCOLEPSY
 Eating light meals during the day
 Avoiding heavy meals before important events
 Napping after meals
 Informing teachers and employers about the disorder
 Go to sleep at the same time each night, even on weekends.
 Wake up at the same time each morning, even on weekends.
 Try to get at least 8 hours of sleep each night, although you may require more.
 Get some form of exercise every day.
 Avoid using electronics in bed or close to bedtime.

18. POSSIBLE COMPLICATIONS
 May endanger life if sleep attacks occur while driving, operating machinery, etc.
 Impairment of functioning at work
 Impairment of social activities
 Side effects of medicines used to treat the disorder
 When left untreated, narcolepsy can be socially disabling and isolating.
 It often leads to the onset of depression.
 Type 2 diabetes mellitus may occur more often in people with narcolepsy.
 Narcolepsy with cataplexy is often associated with increased body mass index.

19. ANY QUESTIONS????

20. THANK YOU