Definition, types, etiology, risk factor , diagnosis and treatment

1. NARCOLEPSY
BY
SUMAIYA FATHIMA S
PHARM D 4TH YEAR 1

2. CONTENTS
• DEFINITION
• EPIDEMIOLOGY
• TYPES
• AETIOLOGY
• RISK FACTORS
• PATHOPHYSIOLOGY
• SIGNS AND SYMPTOMS
• DIAGNOSIS
• TREATMENT
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3. DEFINITION
• Narcolepsy is a chronic neurological disorder which
affects the ability of brain to control sleep-wake cycles.
• NARCO – numbness LEPSY – seizure
• It is characterised by overwhelming day time drowsiness
and sudden attacks of sleep during an activity eg
talking,eating…etc
• Narcolepsy is rare condition – it affects the quality of life
• It is categorised as Dyssomnia under primary sleep
disorders.
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4. EPIDEMIOLOGY
• It affects about 1 in 2,000 people.
• It is common in both men and women.
TYPES OF NARCOLEPSY
• Type 1 Narcolepsy (narcolepsy with cataplexy)
• Type 2 Narcolepsy (narcolepsy without cataplexy)
• Secondary Narcolepsy
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5. TYPE 1 NARCOLEPSY
• 20-30% of people will have this type of narcolepsy
• Otherwise called as narcolepsy with cataplexy
• In this type the level of hypocretin is low
• Which leads to extreme tendency to fall asleep during
daytime
• Symptoms: cataplexy,vivid,scary hallucinations,brief
episodes of paralysis while sleeping or upon awakening
– called sleep paralysis.
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7. CATAPLEXY??
• It is a Sudden loss of muscle tone triggered by strong
emotions like surprise,anger,laughter…etc
• It causes drooping eyes,loss of grip,jaw drop and
weakens knee and may lead to fall.
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8. TYPE 2 NARCOLEPSY
• 10% of people will get this type of narcolepsy
• It is otherwise called as narcolepsy without cataplexy
• People with this condition experiences excessive
daytime sleepiness without muscle weakness
• Less severe symptoms and have normal level of brain
hormone- hypocretin.
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9. SECONDARY NARCOLEPSY
• It results from injury to the Hypothalamus
Which regulates the sleep
• It can be also caused due to underlying medical
conditions like multiple sclerosis, brain tumor.
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10. AETIOLOGY
• Low level of hypocretin/orexin
• Autoimmune disorder – where the immune system
attacks the hypocretin producing cells
• Family history (10% may cause narcolepsy)
• Genetic factors
• Brain injury
• Infection
• Drugs like steroids,beta blockers,diet pills.
• Hormonal changes
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11. RISK FACTORS
• Age – between 10-20 years
• Family history
• Cigarette smoke
• Physical inactivity
• Poor sleep pattern
• Unhealthy diet
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12. PATHOPHYSIOLOGY
Trauma to the Deficiency of hypocretin Genetic factors
hypothalamus neurons due to eg HLA haplotype
autoimmune disorder gene
Abnormality in neurotransmitter (hypocretin) functioning and
sensitivity
Abnormalities in serotonin,histamine,acetycholine and Dopamine
synaptic neurotransmission
Dysfunction and inappropriate regulation of REM sleep
Increases cataplexy and daytime sleep
NARCOLEPSY
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13. SIGNS AND SYMPTOMS
• C – ataplexy ( in type1 only)
• H – allucinations (scary)
• E – xcessive daytime sleep (EDS) important 5 signs
• S – leep paralysis ( in type1 only)
• S – leep disruption
• Fragmented sleep
• Insomnia
• Fatigue
• Automatically sleep during an activity
• Cataplexy includes drooping eyes,jaw drop,loss of grip and
fall
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14. DIAGNOSIS
1) POLYSOMOGRAM (PSG) : patients usually stays
overnight at sleep centre for a PSG test. It records brain
activity,eye movement,heart rate and blood pressure
using electroencephalogram,electroculogram,ECG..etc
2) MULTIPLE SLEEP LATENCY TEST : It monitors the
brain activity during the daytime and also to see how
quickly the pts fall asleep and how long it takes to reach
various stages of sleep, it is often done after PSG.
3) DSM-4 diagnostic criteria for narcolepsy based on signs
and symptoms.
4) ICSD-3 (International classification of sleep disorders)
from this narcolepsy can be classified
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15. TREATMENT
GOALS OF THERAPY:
1) To maximise alertness during waking hours and
improve the quality of the life
2) Encourage good sleep hygiene
PHARMACOTHERAPY:
1) To treat EDS
2) To treat cataplexy and Sleep paralysis
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16. TREATMENT OF EDS
STIMULANTS:
 Dextroamphetamine ---- 5-60 mg
 Methamphetamine ---- 5-15 mg
 Methylphenidate ---- 30-80 mg
 Lisdexamfetamine ---- 20-70 mg
 Pemoline ---- 18.5-112.5 mg
 Modafinil & Armonafidil (non-amphetamine stimulant)
200-400 mg
MECHANISM OF ACTION
They enhance the nor epinephrine release from the presynaptic
neurons and thus promotes wakefulness
ADR:
Abuse,headache,insomnia,nervousness,agitation,confusion,trem
or,anxiety,hypertension,palpitation,tachycardia and mania
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17. SODIUM OXYBATE : 4.5-9 g/night
 CLASS : CNS depressants
 MOA : It is an neuromodulator of GABA , Dopamine and
serotonin thus promote wakefulness exact mechanism is
unknown
 ADR : Respiratory
depression,dizziness,nausea,runnynose,loss of
appetite,insomnia,vertigo,tremor,balance disorders.
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18. TREATMENT OF CATAPLEXY AND
SLEEP PARALYSIS
ANTIDEPRESSANTS
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DRUG DOSE MOA ADR
TCA
Imipramine
Protriptyline
Nortriptyline
50-250mg Blocks nor
epinephrine and
serotonin reuptake
and reduces
cataplexy and
sleep paralysis
Slows down the
brain activity
during sleep by
affecting nerve
pathways
Dry mouth,blurred
vision,constipation,ur
inary
hesitancy,tachycardia,
hypertension.
Headaches,nausea,
vomiting,drowsiness,
agitation,
numbness
5-30mg
50-200mg
MOA-B inhibitors
Selegine
20-40mg
HYDROXYBUTYRATE
Gamma hydroxy
butyrate GHB
60mg/kg @ night

19. NON PHARMACOLOGICAL
TREAMENT
• Avoid caffeine
• Avoid alcohol consumption
• Avoid datytime naps
• Maintain a regular sleep routine
• Exercise for atleast 30 minutes daily
• Precautions should be taken while driving
• Have a quiet , comfortable sleep place
• Don’t watch TV ,use laptop or read in bed
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