Narcolepsy - Current drug treatment options

Narcolepsy is a lifelong neurological sleep/wake disorder with a strong psychosocial impact. It is characterised by excessive daytime sleepiness and recurrent daily sleep attacks, and cataplexy (i.e. the loss of motor control upon experiencing strong emotions). This review summarises the current management options for narcolepsy, focusing on medication. It is, however, important to also consider nonpharmacological treatment aspects in order to achieve optimal results. The majority of patients need medication for the 2 main symptoms. Drugs with CNS stimulating effects, mostly of the amphetamine-type, are used to alleviate excessive sleepiness and sleep attacks. The resulting increased level of vigilance also decreases or abolishes cataplexy in a number of patients. If this is not achieved, tricyclic antidepressants, in the first instance, and selective serotonin (5-hydroxytryptamine; 5-HT) reuptake inhibitors, in the second instance, can be used to control cataplexy and other rapid eye movement (REM) sleep-related symptoms. The number of effective medications for the treatment of narcolepsy has significantly increased during the last decades. Nevertheless, many of these are far from satisfactory. The therapeutic index of the preparations used is narrow and the responses are highly variable. However, it has been estimated that up to 80% of patients may significantly benefit from an adequate treatment.