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Pech de Laclause A, Konofal E, Bokov P, Delclaux C, Lecendreux M. Adjustment to lockdown in children and adolescents with narcolepsy in France. J Clin Sleep Med 2022; 18:2247-2252. [PMID: 35698456 PMCID: PMC9435340 DOI: 10.5664/jcsm.10096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 04/27/2022] [Accepted: 04/27/2022] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES The goal of the current study was to explore the effect of a 2-month quarantine on children and adolescents with narcolepsy and to describe the changes in their sleep, mood, and metabolism during this period. METHODS The study involved 77 patients aged 7 to 23 years with a diagnosis of narcolepsy. Participants had to answer multiple-choice questions to characterize the changes and modifications in their own habits and state of health. RESULTS Participants reported changes in daytime sleep, nighttime sleep schedules, treatment intake, food intake, weight, and amount of screen time. Most patients reported deterioration in their memory and attention abilities as well as a decrease in their work efficiency. Mood appeared to be less affected, although it deteriorated in less than one-third of the participants who reported feeling sad more often. CONCLUSIONS The prolonged and complete lockdown seemed to have an effect on children and adolescents with narcolepsy, and changes are often considered by the participants to depend on or to determine an overall quality of adaptation to the situation. This study highlights the importance of maintaining and strengthening time markers in individuals with narcolepsy and should help to establish guidelines that would apply in future quarantine situations. CITATION de Laclause AP, Konofal E, Bokov P, Delclaux C, Lecendreux M. Adjustment to lockdown in children and adolescents with narcolepsy in France. J Clin Sleep Med. 2022;18(9):2247-2252.
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Affiliation(s)
| | - Eric Konofal
- Pediatric Sleep Center, Hospital Robert-Debré, Paris, France
| | - Plamen Bokov
- Pediatric Sleep Center, Hospital Robert-Debré, Paris, France
- Université Paris, Diderot, Sorbonne Paris Cité, Faculté de Médecine, Paris, France
- INSERM, UMR1141, Paris, France
| | - Christophe Delclaux
- Pediatric Sleep Center, Hospital Robert-Debré, Paris, France
- Université Paris, Diderot, Sorbonne Paris Cité, Faculté de Médecine, Paris, France
- INSERM, UMR1141, Paris, France
| | - Michel Lecendreux
- Pediatric Sleep Center, Hospital Robert-Debré, Paris, France
- National Reference Center for Narcolepsy and Rare Hypersomnias, Hospital Robert-Debré, Paris, France
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Chung IH, Chin WC, Huang YS, Wang CH. Pediatric Narcolepsy-A Practical Review. CHILDREN (BASEL, SWITZERLAND) 2022; 9:974. [PMID: 35883958 PMCID: PMC9320719 DOI: 10.3390/children9070974] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 06/21/2022] [Accepted: 06/24/2022] [Indexed: 11/16/2022]
Abstract
Pediatric narcolepsy is a chronic sleep-wakefulness disorder. Its symptoms frequently begin in childhood. This review article examined the literature for research reporting on the effects of treatment of pediatric narcolepsy, as well as proposed etiology and diagnostic tools. Symptoms of pediatric narcolepsy include excessive sleepiness and cataplexy. In addition, rapid-eye-movement-related phenomena such as sleep paralysis, sleep terror, and hypnagogic or hypnapompic hallucinations can also occur. These symptoms impaired children's function and negatively influenced their social interaction, studying, quality of life, and may further lead to emotional and behavioral problems. Therefore, early diagnosis and intervention are essential for children's development. Moreover, there are differences in clinical experiences between Asian and Western population. The treatment of pediatric narcolepsy should be comprehensive. In this article, we review pediatric narcolepsy and its treatment approach: medication, behavioral modification, and education/mental support. Pharmacological treatment including some promising newly-developed medication can decrease cataplexy and daytime sleepiness in children with narcolepsy. Other forms of management such as psychosocial interventions involve close cooperation between children, school, family, medical personnel, and can further assist their adjustment.
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Affiliation(s)
- I-Hang Chung
- Department of Child Psychiatry and Sleep Center, Chang Gung Memorial Hospital and College of Medicine, Taoyuan 333, Taiwan; (I.-H.C.); (W.-C.C.)
| | - Wei-Chih Chin
- Department of Child Psychiatry and Sleep Center, Chang Gung Memorial Hospital and College of Medicine, Taoyuan 333, Taiwan; (I.-H.C.); (W.-C.C.)
| | - Yu-Shu Huang
- Department of Child Psychiatry and Sleep Center, Chang Gung Memorial Hospital and College of Medicine, Taoyuan 333, Taiwan; (I.-H.C.); (W.-C.C.)
| | - Chih-Huan Wang
- Department of Psychology, Zhejiang Normal University, Jinhua 321004, China;
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Yu YA. Pediatric Sleep Medicine Cases. CURRENT SLEEP MEDICINE REPORTS 2022; 8:21-32. [PMID: 35345531 PMCID: PMC8943358 DOI: 10.1007/s40675-022-00223-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2022] [Indexed: 11/13/2022]
Abstract
Purpose of the Review In this review, we will discuss commonly encountered pediatric sleep disorders, their clinical presentations, evaluation, and management. Recent Findings Sleep problems are common complaints in the pediatric population with an estimated prevalence of at least 25%. This review examines frequently seen pediatric sleep disorders including insomnia, obstructive sleep apnea, hypersomnolence, circadian rhythm sleep–wake disorders, parasomnias, and movement disorders. Their clinical manifestations vary, but left untreated, these sleep disorders result in significant impairment. A detailed sleep history is key component in the evaluation process. Other useful tools include sleep diaries, questionnaires, and actigraphy. Polysomnography is often required for diagnosis. Treatment varies depending on the underlying sleep disorder. Pharmacologic treatment is often limited due to the lack of studies of safety and efficacy in the pediatric population. Summary Sleep disorders are commonly encountered in the pediatric population. Their clinical manifestations vary, though without treatment, many result in significant impairment. Detailed sleep history is an essential part of the evaluation process, though polysomnography is often required. Treatment depends on the underlying diagnosis.
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Affiliation(s)
- Yolanda A Yu
- Division of Pediatric Pulmonology and Sleep Medicine, Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA USA
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Blackwell JE, Kingshott RN, Weighall A, Elphick HE, Nash H. Paediatric narcolepsy: a review of diagnosis and management. Arch Dis Child 2022; 107:7-11. [PMID: 33975822 DOI: 10.1136/archdischild-2020-320671] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 04/09/2021] [Accepted: 04/15/2021] [Indexed: 11/03/2022]
Abstract
Narcolepsy is a chronic disabling neurological sleep disorder that requires lifelong treatment. We have outlined the clinical features of narcolepsy, the assessment and diagnosis process and have summarised the existing treatment options for children and adolescents with narcolepsy. In the future, the approach to management of paediatric narcolepsy should ideally be in a multidisciplinary setting, involving specialists in sleep medicine, sleep physiology, neurologists and psychologists/psychiatrists. A multidisciplinary approach will help to manage the potential impact of narcolepsy on children and adolescents who are in a stage of their life that is critical to their physical, emotional and social development and their academic attainment.
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Affiliation(s)
- Jane Elizabeth Blackwell
- The Child Oriented Mental Health Intervention Centre, Leeds and York Partnership NHS Foundation Trust, York, UK
| | - Ruth N Kingshott
- Department of Respiratory Medicine, Sheffield Children's Hospital, Sheffield, UK
| | - Anna Weighall
- School of Education, The University of Sheffield, Sheffield, UK
| | - Heather E Elphick
- Department of Respiratory Medicine, Sheffield Children's Hospital, Sheffield, UK
| | - Hannah Nash
- School of Psychology, University of Leeds, Leeds, UK
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Lecendreux M, Plazzi G, Franco P, Jacqz-Aigrain E, Robert P, Duvauchelle T, Schwartz JC. Pharmacokinetics of pitolisant in children and adolescents with narcolepsy. Sleep Med 2020; 66:220-226. [DOI: 10.1016/j.sleep.2019.10.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 10/28/2019] [Accepted: 10/31/2019] [Indexed: 11/28/2022]
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Pérez-Carbonell L. Treatment of Excessive Daytime Sleepiness in Patients with Narcolepsy. Curr Treat Options Neurol 2019; 21:57. [DOI: 10.1007/s11940-019-0595-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Filardi M, Pizza F, Antelmi E, Ferri R, Natale V, Plazzi G. In-field assessment of sodium oxybate effect in pediatric type 1 narcolepsy: an actigraphic study. Sleep 2019. [PMID: 29522206 DOI: 10.1093/sleep/zsy050] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Study Objectives Sodium oxybate (SXB) is a GABAergic agent widely used as off-label treatment in pediatric type 1 narcolepsy (NT1). Here, we aimed at analyzing by wrist actigraphy the sleep/wake profile of NT1 children and adolescents in drug-naïve condition and after 1 year of SXB treatment. As secondary aim, we investigated changes on sleepiness, cataplexy, and children's anthropometric profile after 1 year of SXB treatment. Methods Twenty-four drug-naïve NT1 children underwent 7 days of actigraphy during the school week. Information on sleepiness, narcolepsy symptoms, and anthropometric features were collected during the same week with questionnaires and semistructured clinical interview. Children started SXB treatment and underwent a second evaluation encompassing actigraphy, clinical interview, questionnaires, and anthropometric assessment after 1 year of stable treatment. Results Actigraphy effectively documented an improvement of nocturnal sleep quality and duration coupled with a reduction of diurnal total sleep time, nap frequency, and duration at 1 year follow-up. Reduction of sleepiness, cataplexy frequency and severity, and weight loss, mainly in obese and overweight NT1 children, were also observed at the 1 year follow-up. Conclusions Actigraphy objectively documented changes in nocturnal sleep quality and diurnal napping behavior after 1 year of SXB treatment, thus representing a valid approach to ecologically assess SXB treatment effect on NT1 children's sleep/wake profile. NT1 symptoms severity and children's anthropometric features also changed as expected. Actigraphy offers the possibility to longitudinally follow up children and has potential to become a key tool to tailor treatment in pediatric patients.
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Affiliation(s)
- Marco Filardi
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Fabio Pizza
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy.,IRCCS, Istituto delle Scienze Neurologiche, AUSL di Bologna, Bologna, Italy
| | - Elena Antelmi
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy.,IRCCS, Istituto delle Scienze Neurologiche, AUSL di Bologna, Bologna, Italy
| | - Raffaele Ferri
- Department of Neurology I.C., Sleep Research Centre, Oasi Institute for Research on Mental Retardation and Brain Aging (IRCCS), Troina, Italy
| | - Vincenzo Natale
- Department of Psychology, University of Bologna, Bologna, Italy
| | - Giuseppe Plazzi
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy.,IRCCS, Istituto delle Scienze Neurologiche, AUSL di Bologna, Bologna, Italy
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Hill CM. Treatment of paediatric narcolepsy with sodium oxybate. THE LANCET. CHILD & ADOLESCENT HEALTH 2018; 2:466-467. [PMID: 30169309 DOI: 10.1016/s2352-4642(18)30172-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 05/17/2018] [Indexed: 06/08/2023]
Affiliation(s)
- Catherine M Hill
- Mail point 803CB, G-Level, University Hospital Southampton Tremona Road, Southampton, SO16 6YD, UK.
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Abstract
PURPOSE OF REVIEW This article focuses on the clinical presentation, pathophysiology, diagnosis, differential diagnosis, and management of narcolepsy type 1 and narcolepsy type 2, idiopathic hypersomnia, Kleine-Levin syndrome, and other central disorders of hypersomnolence, as defined in the International Classification of Sleep Disorders, Third Edition (ICSD-3). RECENT FINDINGS In ICSD-3, the names of some central disorders of hypersomnolence have been changed: narcolepsy with cataplexy and narcolepsy without cataplexy have been renamed narcolepsy type 1 and narcolepsy type 2, respectively. A low level of hypocretin-1/orexin-A in the CSF is now theoretically sufficient to diagnose narcolepsy type 1, as it is a highly specific and sensitive biomarker. Conversely, other central hypersomnias are less well-defined disorders with variability in the phenotype, and few reliable biomarkers have been discovered so far. The epidemiologic observation that influenza A (H1N1) infection and vaccination are potential triggering factors of narcolepsy type 1 (discovered during the 2009 H1N1 pandemic) has increased interest in this rare disease, and progress is being made to better understand the process (highly suspected to be autoimmune) responsible for the destruction of hypocretin neurons. Treatment of narcolepsy remains largely symptomatic, usually initially with modafinil or armodafinil or with higher-potency stimulants such as methylphenidate or amphetamines. Several newer wake-promoting agents and psychostimulants have also been developed, including sodium oxybate, which has a role in the treatment of cataplexy and as an adjunctive wake-promoting agent, and pitolisant, a selective histamine H3 receptor inverse agonist that is currently only available in Europe. SUMMARY Although far less common than many other sleep disorders, central hypersomnias are among the most severe and disabling diseases in the field of sleep medicine, and their early recognition is of major importance for patients, especially children, to maximize their quality of life and functioning in activities of daily living.
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Assessing sleepiness and cataplexy in children and adolescents with narcolepsy: a review of current patient-reported measures. Sleep Med 2017; 32:143-149. [PMID: 28366326 DOI: 10.1016/j.sleep.2016.12.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 12/23/2016] [Accepted: 12/26/2016] [Indexed: 02/02/2023]
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Gehrmann J, Siegler D, Ignacy E, Reimer I. [Narcolepsy in childhood and adolescence: symptoms, diagnosis, and therapy. A case report]. ZEITSCHRIFT FUR KINDER- UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2017; 45:149-157. [PMID: 28320246 DOI: 10.1024/1422-4917/a000461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Narcolepsy is a rare, multifactorial disease of the hypothalamus characterized by its leading symptoms of excessive daytime sleepiness and cataplexy. Sleep-EEG and a HLA-DR-genotype serve to secure the diagnosis. We report here on a 14-year-old girl suffering from anxieties, depression, school refusal, social withdrawal as well as very frequent attacks of sleep during the day and cataplexy. Currently, there is no approved drug for children and adolescents suffering from narcolepsy. Our patient benefited significantly and quickly from an off-label treatment with methylphenidate in combination with psychoeducation, cognitive behavioral therapy, and family therapy. Narcolepsy is a very rare but probably underestimated differential diagnosis applied to unclear daytime sleepiness, anxieties, or depression in childhood and adolescence. Both the key symptoms and the comorbid symptoms improve significantly under treatment with stimulants, albeit at a higher dosage.
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Affiliation(s)
- Jochen Gehrmann
- 1 Klinik für Kinder- und Jugendpsychiatrie und Psychotherapie, Ludwigshafen a. Rh., Deutschland
| | - Dominik Siegler
- 1 Klinik für Kinder- und Jugendpsychiatrie und Psychotherapie, Ludwigshafen a. Rh., Deutschland
| | - Evelin Ignacy
- 1 Klinik für Kinder- und Jugendpsychiatrie und Psychotherapie, Ludwigshafen a. Rh., Deutschland
| | - Inga Reimer
- 1 Klinik für Kinder- und Jugendpsychiatrie und Psychotherapie, Ludwigshafen a. Rh., Deutschland
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Lopez R, Arnulf I, Drouot X, Lecendreux M, Dauvilliers Y. French consensus. Management of patients with hypersomnia: Which strategy? Rev Neurol (Paris) 2017; 173:8-18. [DOI: 10.1016/j.neurol.2016.09.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 09/20/2016] [Indexed: 10/20/2022]
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