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Dauvilliers Y, Lammers GJ, Lecendreux M, Maski K, Kansagra S, Black J, Parvataneni R, Chen A, Wang YG, Plazzi G. Effect of sodium oxybate on body mass index in pediatric patients with narcolepsy. J Clin Sleep Med 2024; 20:445-454. [PMID: 37942930 PMCID: PMC11019206 DOI: 10.5664/jcsm.10912] [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: 06/29/2023] [Revised: 11/06/2023] [Accepted: 11/07/2023] [Indexed: 11/10/2023]
Abstract
STUDY OBJECTIVES We examined body mass index (BMI) changes associated with sodium oxybate treatment (SXB) in pediatric patients with narcolepsy with cataplexy who participated in a double-blind, placebo-controlled, randomized withdrawal study and an open-label continuation period. METHODS Participants were aged 7-16 years at screening. SXB-naive participants titrated to twice-nightly dosing of SXB then entered a 2-week stable-dose period; participants taking SXB at study entry entered a 3-week stable-dose period. After a 2-week randomized withdrawal period, all participants entered an open-label safety period (OLP; main study duration: ≤ 52 weeks). Participants who completed the OLP were allowed to enter the open-label continuation period (an additional 1-2 years). BMI percentile categories were defined as underweight (< 5th), normal (5th to < 85th), overweight (≥ 85th to < 95th), and obese (≥ 95th). RESULTS Median BMI percentile decreased from baseline to OLP week 52 in SXB-naive participants who were normal weight at baseline (decreased from 77.0 to 35.0) or overweight/obese at baseline (98.0 to 86.7). Median BMI percentile decreased to a lesser extent in participants taking twice-nightly SXB at study entry who were normal weight at baseline (54.6 to 53.0) or overweight/obese at baseline (96.5 to 88.9). Shifts in BMI category from baseline to week 52 were sometimes noted. In SXB-naive participants, 9/10 (90.0%) who were overweight became normal weight, 7/25 (28.0%) who were obese became normal weight, 3/25 (12.0%) who were obese became overweight, and 1/16 (6.3%) who was normal weight became obese. In participants taking SXB at baseline, 5/8 (62.5%) who were overweight became normal weight, 3/6 (50.0%) who were obese became overweight, 1/14 (7.1%) who was normal weight became overweight, and 2/14 (14.3%) who were normal weight became underweight. Median BMI percentiles at months 6 and 12 of the open-label continuation period were similar to those at OLP end (OLP week 52). In SXB-naive participants, the evident BMI z-score decrease over time was relative to the screening values. CONCLUSIONS Decreases in BMI percentile and z-score, and downward shifts in BMI category, were observed within 1 year of SXB treatment in pediatric participants with narcolepsy with cataplexy. BMI decreases plateaued after approximately 1 year. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Name: A Multicenter Study of the Efficacy and Safety of Xyrem With an Open-Label Pharmacokinetic Evaluation and Safety Extension in Pediatric Subjects With Narcolepsy With Cataplexy; URL: https://clinicaltrials.gov/study/NCT02221869; Identifier: NCT02221869. CITATION Dauvilliers Y, Lammers GJ, Lecendreux M, et al. Effect of sodium oxybate on body mass index in pediatric patients with narcolepsy. J Clin Sleep Med. 2024;20(3):445-454.
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Affiliation(s)
- Yves Dauvilliers
- Sleep and Wake Disorders Centre, Department of Neurology, Gui de Chauliac Hospital, Montpellier, France
- University of Montpellier, INSERM Institute Neuroscience Montpellier (INM), Montpellier, France
- National Reference Center for Orphan Diseases, Narcolepsy and Central Hypersomnias, Paris, France
| | - Gert Jan Lammers
- Sleep Wake Center SEIN Heemstede, Stichting Epilepsie Instellingen Nederland, North Holland, The Netherlands
- Leiden University Medical Centre, Department of Neurology, South Holland, The Netherlands
| | - Michel Lecendreux
- National Reference Center for Orphan Diseases, Narcolepsy and Central Hypersomnias, Paris, France
- AP-HP, Pediatric Sleep Center, Hospital Robert-Debré, Paris, France
- INSERM CIC 1426, Paris, France
| | - Kiran Maski
- Department of Neurology, Boston Children’s Hospital, Boston, Massachusetts
| | - Sujay Kansagra
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
| | - Jed Black
- Stanford University Center for Sleep Sciences and Medicine, Palo Alto, California
- Jazz Pharmaceuticals, Palo Alto, California
| | | | - Abby Chen
- Jazz Pharmaceuticals, Palo Alto, California
| | | | - Giuseppe Plazzi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio-Emilia, Modena, Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
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Pizza F, Vignatelli L, Vandi S, Zenesini C, Biscarini F, Franceschini C, Antelmi E, Ingravallo F, Mignot E, Bruni O, Nobili L, Veggiotti P, Ferri R, Plazzi G. Role of Daytime Continuous Polysomnography in the Diagnosis of Pediatric Narcolepsy Type 1. Neurology 2024; 102:e207815. [PMID: 38165365 PMCID: PMC10834121 DOI: 10.1212/wnl.0000000000207815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 09/18/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Narcolepsy type 1 (NT1) is still largely underdiagnosed or diagnosed too late in children. Difficulties in obtaining rapid and reliable diagnostic evaluations of the condition in clinical practice partially explain this problem. Predictors of NT1 include cataplexy and sleep-onset REM periods (SOREMPs), documented during nocturnal polysomnography (N-PSG) or through the multiple sleep latency test (MSLT), although low CSF hypocretin-1 (CSF hcrt-1) is the definitive biological disease marker. Obtaining reliable MSLT results is not always feasible in children; therefore, this study aimed to validate daytime continuous polysomnography (D-PSG) as an alternative diagnostic tool. METHODS Two hundred consecutive patients aged younger than 18 years (112 with NT1; 25 with other hypersomnias, including narcolepsy type 2 and idiopathic hypersomnia; and 63 with subjective excessive daytime sleepiness) were randomly split into 2 groups: group 1 (n = 133) for the identification of diagnostic markers and group 2 (n = 67) for the validation of the detected markers. The D-PSG data collected included the number of spontaneous naps, total sleep time, and the number of daytime SOREMPs (d-SOREMP). D-PSG data were tested against CSF hcrt-1 deficiency (NT1 diagnosis) as the gold standard using receiver operating characteristic (ROC) curve analysis in group 1. ROC diagnostic performances of single and combined D-PSG parameters were tested in group 1 and validated in group 2. RESULTS In group 1, the areas under the ROC curve (AUCs) were 0.91 (95% CI 0.86-0.96) for d-SOREMPs, 0.81 (95% CI 0.74-0.89) for the number of spontaneous naps, and 0.70 (95% CI 0.60-0.79) for total sleep time. A d-SOREMP count ≥1 (sensitivity of 95% and specificity of 72%), coupled with a diurnal total sleep time above 60 minutes (sensitivity of 89% and specificity of 91%), identified NT1 in group 1 with high reliability (area under the ROC curve of 0.93, 95% CI 0.88-0.97). These results were confirmed in the validation group with an AUC of 0.88 (95% CI 0.79-0.97). DISCUSSION D-PSG recording is an easily performed, cost-effective, and reliable tool for identifying NT1 in children. Further studies should confirm its validity with home D-PSG monitoring. These alternative procedures could be used to confirm NT1 diagnosis and curtail diagnostic delay.
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Affiliation(s)
- Fabio Pizza
- From the Department of Biomedical and Neuromotor Sciences (DIBINEM) (F.P., S.V., F.B.), University of Bologna; IRCCS Istituto delle Scienze Neurologiche di Bologna (F.P., L.V., S.V., C.Z., G.P.); Department of Medicine and Surgery (C.F.), University of Parma; Neurology Unit (E.A.), Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona; Department of Medical and Surgical Sciences (DIMEC) (F.I.), University of Bologna, Italy; Tanford University Center for Sleep Sciences (E.M.), Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA; Department of Developmental and Social Psychology (O.B.), Sapienza University, Rome; IRCCS Istituto Giannina Gaslini (L.N.), Genoa; Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (L.N.), DINOGMI, University of Genoa; University of Milan (P.V.), Milan; Clinical Neurophysiology Research Unit (R.F.), Oasi Research Institute-IRCCS, Troina; and Department of Biomedical, Metabolic and Neural Sciences (G.P.), University of Modena and Reggio-Emilia, Italy
| | - Luca Vignatelli
- From the Department of Biomedical and Neuromotor Sciences (DIBINEM) (F.P., S.V., F.B.), University of Bologna; IRCCS Istituto delle Scienze Neurologiche di Bologna (F.P., L.V., S.V., C.Z., G.P.); Department of Medicine and Surgery (C.F.), University of Parma; Neurology Unit (E.A.), Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona; Department of Medical and Surgical Sciences (DIMEC) (F.I.), University of Bologna, Italy; Tanford University Center for Sleep Sciences (E.M.), Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA; Department of Developmental and Social Psychology (O.B.), Sapienza University, Rome; IRCCS Istituto Giannina Gaslini (L.N.), Genoa; Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (L.N.), DINOGMI, University of Genoa; University of Milan (P.V.), Milan; Clinical Neurophysiology Research Unit (R.F.), Oasi Research Institute-IRCCS, Troina; and Department of Biomedical, Metabolic and Neural Sciences (G.P.), University of Modena and Reggio-Emilia, Italy
| | - Stefano Vandi
- From the Department of Biomedical and Neuromotor Sciences (DIBINEM) (F.P., S.V., F.B.), University of Bologna; IRCCS Istituto delle Scienze Neurologiche di Bologna (F.P., L.V., S.V., C.Z., G.P.); Department of Medicine and Surgery (C.F.), University of Parma; Neurology Unit (E.A.), Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona; Department of Medical and Surgical Sciences (DIMEC) (F.I.), University of Bologna, Italy; Tanford University Center for Sleep Sciences (E.M.), Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA; Department of Developmental and Social Psychology (O.B.), Sapienza University, Rome; IRCCS Istituto Giannina Gaslini (L.N.), Genoa; Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (L.N.), DINOGMI, University of Genoa; University of Milan (P.V.), Milan; Clinical Neurophysiology Research Unit (R.F.), Oasi Research Institute-IRCCS, Troina; and Department of Biomedical, Metabolic and Neural Sciences (G.P.), University of Modena and Reggio-Emilia, Italy
| | - Corrado Zenesini
- From the Department of Biomedical and Neuromotor Sciences (DIBINEM) (F.P., S.V., F.B.), University of Bologna; IRCCS Istituto delle Scienze Neurologiche di Bologna (F.P., L.V., S.V., C.Z., G.P.); Department of Medicine and Surgery (C.F.), University of Parma; Neurology Unit (E.A.), Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona; Department of Medical and Surgical Sciences (DIMEC) (F.I.), University of Bologna, Italy; Tanford University Center for Sleep Sciences (E.M.), Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA; Department of Developmental and Social Psychology (O.B.), Sapienza University, Rome; IRCCS Istituto Giannina Gaslini (L.N.), Genoa; Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (L.N.), DINOGMI, University of Genoa; University of Milan (P.V.), Milan; Clinical Neurophysiology Research Unit (R.F.), Oasi Research Institute-IRCCS, Troina; and Department of Biomedical, Metabolic and Neural Sciences (G.P.), University of Modena and Reggio-Emilia, Italy
| | - Francesco Biscarini
- From the Department of Biomedical and Neuromotor Sciences (DIBINEM) (F.P., S.V., F.B.), University of Bologna; IRCCS Istituto delle Scienze Neurologiche di Bologna (F.P., L.V., S.V., C.Z., G.P.); Department of Medicine and Surgery (C.F.), University of Parma; Neurology Unit (E.A.), Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona; Department of Medical and Surgical Sciences (DIMEC) (F.I.), University of Bologna, Italy; Tanford University Center for Sleep Sciences (E.M.), Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA; Department of Developmental and Social Psychology (O.B.), Sapienza University, Rome; IRCCS Istituto Giannina Gaslini (L.N.), Genoa; Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (L.N.), DINOGMI, University of Genoa; University of Milan (P.V.), Milan; Clinical Neurophysiology Research Unit (R.F.), Oasi Research Institute-IRCCS, Troina; and Department of Biomedical, Metabolic and Neural Sciences (G.P.), University of Modena and Reggio-Emilia, Italy
| | - Christian Franceschini
- From the Department of Biomedical and Neuromotor Sciences (DIBINEM) (F.P., S.V., F.B.), University of Bologna; IRCCS Istituto delle Scienze Neurologiche di Bologna (F.P., L.V., S.V., C.Z., G.P.); Department of Medicine and Surgery (C.F.), University of Parma; Neurology Unit (E.A.), Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona; Department of Medical and Surgical Sciences (DIMEC) (F.I.), University of Bologna, Italy; Tanford University Center for Sleep Sciences (E.M.), Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA; Department of Developmental and Social Psychology (O.B.), Sapienza University, Rome; IRCCS Istituto Giannina Gaslini (L.N.), Genoa; Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (L.N.), DINOGMI, University of Genoa; University of Milan (P.V.), Milan; Clinical Neurophysiology Research Unit (R.F.), Oasi Research Institute-IRCCS, Troina; and Department of Biomedical, Metabolic and Neural Sciences (G.P.), University of Modena and Reggio-Emilia, Italy
| | - Elena Antelmi
- From the Department of Biomedical and Neuromotor Sciences (DIBINEM) (F.P., S.V., F.B.), University of Bologna; IRCCS Istituto delle Scienze Neurologiche di Bologna (F.P., L.V., S.V., C.Z., G.P.); Department of Medicine and Surgery (C.F.), University of Parma; Neurology Unit (E.A.), Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona; Department of Medical and Surgical Sciences (DIMEC) (F.I.), University of Bologna, Italy; Tanford University Center for Sleep Sciences (E.M.), Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA; Department of Developmental and Social Psychology (O.B.), Sapienza University, Rome; IRCCS Istituto Giannina Gaslini (L.N.), Genoa; Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (L.N.), DINOGMI, University of Genoa; University of Milan (P.V.), Milan; Clinical Neurophysiology Research Unit (R.F.), Oasi Research Institute-IRCCS, Troina; and Department of Biomedical, Metabolic and Neural Sciences (G.P.), University of Modena and Reggio-Emilia, Italy
| | - Francesca Ingravallo
- From the Department of Biomedical and Neuromotor Sciences (DIBINEM) (F.P., S.V., F.B.), University of Bologna; IRCCS Istituto delle Scienze Neurologiche di Bologna (F.P., L.V., S.V., C.Z., G.P.); Department of Medicine and Surgery (C.F.), University of Parma; Neurology Unit (E.A.), Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona; Department of Medical and Surgical Sciences (DIMEC) (F.I.), University of Bologna, Italy; Tanford University Center for Sleep Sciences (E.M.), Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA; Department of Developmental and Social Psychology (O.B.), Sapienza University, Rome; IRCCS Istituto Giannina Gaslini (L.N.), Genoa; Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (L.N.), DINOGMI, University of Genoa; University of Milan (P.V.), Milan; Clinical Neurophysiology Research Unit (R.F.), Oasi Research Institute-IRCCS, Troina; and Department of Biomedical, Metabolic and Neural Sciences (G.P.), University of Modena and Reggio-Emilia, Italy
| | - Emmanuel Mignot
- From the Department of Biomedical and Neuromotor Sciences (DIBINEM) (F.P., S.V., F.B.), University of Bologna; IRCCS Istituto delle Scienze Neurologiche di Bologna (F.P., L.V., S.V., C.Z., G.P.); Department of Medicine and Surgery (C.F.), University of Parma; Neurology Unit (E.A.), Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona; Department of Medical and Surgical Sciences (DIMEC) (F.I.), University of Bologna, Italy; Tanford University Center for Sleep Sciences (E.M.), Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA; Department of Developmental and Social Psychology (O.B.), Sapienza University, Rome; IRCCS Istituto Giannina Gaslini (L.N.), Genoa; Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (L.N.), DINOGMI, University of Genoa; University of Milan (P.V.), Milan; Clinical Neurophysiology Research Unit (R.F.), Oasi Research Institute-IRCCS, Troina; and Department of Biomedical, Metabolic and Neural Sciences (G.P.), University of Modena and Reggio-Emilia, Italy
| | - Oliviero Bruni
- From the Department of Biomedical and Neuromotor Sciences (DIBINEM) (F.P., S.V., F.B.), University of Bologna; IRCCS Istituto delle Scienze Neurologiche di Bologna (F.P., L.V., S.V., C.Z., G.P.); Department of Medicine and Surgery (C.F.), University of Parma; Neurology Unit (E.A.), Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona; Department of Medical and Surgical Sciences (DIMEC) (F.I.), University of Bologna, Italy; Tanford University Center for Sleep Sciences (E.M.), Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA; Department of Developmental and Social Psychology (O.B.), Sapienza University, Rome; IRCCS Istituto Giannina Gaslini (L.N.), Genoa; Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (L.N.), DINOGMI, University of Genoa; University of Milan (P.V.), Milan; Clinical Neurophysiology Research Unit (R.F.), Oasi Research Institute-IRCCS, Troina; and Department of Biomedical, Metabolic and Neural Sciences (G.P.), University of Modena and Reggio-Emilia, Italy
| | - Lino Nobili
- From the Department of Biomedical and Neuromotor Sciences (DIBINEM) (F.P., S.V., F.B.), University of Bologna; IRCCS Istituto delle Scienze Neurologiche di Bologna (F.P., L.V., S.V., C.Z., G.P.); Department of Medicine and Surgery (C.F.), University of Parma; Neurology Unit (E.A.), Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona; Department of Medical and Surgical Sciences (DIMEC) (F.I.), University of Bologna, Italy; Tanford University Center for Sleep Sciences (E.M.), Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA; Department of Developmental and Social Psychology (O.B.), Sapienza University, Rome; IRCCS Istituto Giannina Gaslini (L.N.), Genoa; Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (L.N.), DINOGMI, University of Genoa; University of Milan (P.V.), Milan; Clinical Neurophysiology Research Unit (R.F.), Oasi Research Institute-IRCCS, Troina; and Department of Biomedical, Metabolic and Neural Sciences (G.P.), University of Modena and Reggio-Emilia, Italy
| | - Pierangelo Veggiotti
- From the Department of Biomedical and Neuromotor Sciences (DIBINEM) (F.P., S.V., F.B.), University of Bologna; IRCCS Istituto delle Scienze Neurologiche di Bologna (F.P., L.V., S.V., C.Z., G.P.); Department of Medicine and Surgery (C.F.), University of Parma; Neurology Unit (E.A.), Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona; Department of Medical and Surgical Sciences (DIMEC) (F.I.), University of Bologna, Italy; Tanford University Center for Sleep Sciences (E.M.), Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA; Department of Developmental and Social Psychology (O.B.), Sapienza University, Rome; IRCCS Istituto Giannina Gaslini (L.N.), Genoa; Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (L.N.), DINOGMI, University of Genoa; University of Milan (P.V.), Milan; Clinical Neurophysiology Research Unit (R.F.), Oasi Research Institute-IRCCS, Troina; and Department of Biomedical, Metabolic and Neural Sciences (G.P.), University of Modena and Reggio-Emilia, Italy
| | - Raffaele Ferri
- From the Department of Biomedical and Neuromotor Sciences (DIBINEM) (F.P., S.V., F.B.), University of Bologna; IRCCS Istituto delle Scienze Neurologiche di Bologna (F.P., L.V., S.V., C.Z., G.P.); Department of Medicine and Surgery (C.F.), University of Parma; Neurology Unit (E.A.), Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona; Department of Medical and Surgical Sciences (DIMEC) (F.I.), University of Bologna, Italy; Tanford University Center for Sleep Sciences (E.M.), Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA; Department of Developmental and Social Psychology (O.B.), Sapienza University, Rome; IRCCS Istituto Giannina Gaslini (L.N.), Genoa; Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (L.N.), DINOGMI, University of Genoa; University of Milan (P.V.), Milan; Clinical Neurophysiology Research Unit (R.F.), Oasi Research Institute-IRCCS, Troina; and Department of Biomedical, Metabolic and Neural Sciences (G.P.), University of Modena and Reggio-Emilia, Italy
| | - Giuseppe Plazzi
- From the Department of Biomedical and Neuromotor Sciences (DIBINEM) (F.P., S.V., F.B.), University of Bologna; IRCCS Istituto delle Scienze Neurologiche di Bologna (F.P., L.V., S.V., C.Z., G.P.); Department of Medicine and Surgery (C.F.), University of Parma; Neurology Unit (E.A.), Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona; Department of Medical and Surgical Sciences (DIMEC) (F.I.), University of Bologna, Italy; Tanford University Center for Sleep Sciences (E.M.), Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA; Department of Developmental and Social Psychology (O.B.), Sapienza University, Rome; IRCCS Istituto Giannina Gaslini (L.N.), Genoa; Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (L.N.), DINOGMI, University of Genoa; University of Milan (P.V.), Milan; Clinical Neurophysiology Research Unit (R.F.), Oasi Research Institute-IRCCS, Troina; and Department of Biomedical, Metabolic and Neural Sciences (G.P.), University of Modena and Reggio-Emilia, Italy
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Dye TJ. Clinical Evaluation and Management of Narcolepsy in Children and Adolescents. Semin Pediatr Neurol 2023; 48:101089. [PMID: 38065636 DOI: 10.1016/j.spen.2023.101089] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/26/2023] [Accepted: 09/26/2023] [Indexed: 12/18/2023]
Abstract
While sleepiness is common among children, and particularly adolescents, profound sleepiness in the setting of apparently adequate sleep should prompt consideration of a central disorder of hypersomnolence. These disorders, which include narcolepsy, idiopathic hypersomnia, Kleine-Levin syndrome, and others, are likely underrecognized in the pediatric population. Narcolepsy in particular should be of interest to child neurologists as the unique signs and symptoms of this disease often prompt evaluation in pediatric neurology clinics. While sleepiness may appear to be a straightforward complaint, its evaluation requires a nuanced approach. Cataplexy, a hallmark of narcolepsy, can be confused for other neurologic conditions, though understanding its various manifestations makes it readily identifiable. Clinicians should be aware of these symptoms, as delay in diagnosis and misdiagnosis are common in childhood narcolepsy. While treatment options have been limited in the past, many new therapeutic options have become available and can result in significant improvement in symptoms. Given the age at presentation, paroxysmal and chronic features, diagnostic modalities, and available treatment options, the field of child neurology is well equipped to see patients with narcolepsy. In this review, I will focus on the presentation, evaluation, and management of pediatric patients with narcolepsy.
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Affiliation(s)
- Thomas J Dye
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Division of Pulmonary - Sleep Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH.
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Shelton AR. Sleep Disorders in Childhood. Continuum (Minneap Minn) 2023; 29:1205-1233. [PMID: 37590830 DOI: 10.1212/con.0000000000001285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
OBJECTIVE This article provides a comprehensive review of pediatric sleep disorders including the clinical features, diagnosis, and treatment of sleep-disordered breathing, insomnia, parasomnias, restless sleep disorder, restless legs syndrome, narcolepsy in childhood, and Kleine-Levin syndrome. LATEST DEVELOPMENTS Our understanding of pediatric sleep pathophysiology continues to evolve, and diagnostic and treatment modalities have expanded. A low-sodium oxybate formulation was approved in July 2020 in the United States to treat cataplexy and excessive daytime sleepiness in patients 7 years old and older with narcolepsy. A validated pediatric hypersomnolence survey for pediatric narcolepsy and idiopathic hypersomnia with high sensitivity, specificity, and interrater reliability is now available. ESSENTIAL POINTS The clinical presentation, diagnostics, and treatment of children with sleep disorders differ from those of adults. Untreated sleep disorders in childhood can lead to adverse physical and psychological consequences in adults. Correctly diagnosing and treating sleep disorders in youth can prevent a significant burden of disease in adulthood.
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Zhang M, Thieux M, Arvis L, Lin JS, Guyon A, Plancoulaine S, Villanueva C, Franco P. Metabolic disturbances in children with narcolepsy: a retrospective study. Sleep 2023; 46:zsad076. [PMID: 36971181 DOI: 10.1093/sleep/zsad076] [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: 05/10/2022] [Revised: 09/22/2022] [Indexed: 07/20/2023] Open
Abstract
STUDY OBJECTIVES To determine the prevalence of metabolic syndrome (MS) in children with narcolepsy and to evaluate their clinical and sleep characteristics according to the different components of MS. METHODS This retrospective study consisted of 58 de novo children with narcolepsy (median age: 12.7 years, 48.3% of boys). The recently published MS criteria in a French population of children were used. Clinical and sleep characteristics were compared between groups with different components of MS. RESULTS MS was present in 17.2% of children with narcolepsy, among whom 79.3% presented with high homeostasis model assessment for insulin resistance (HOMA-IR), 25.9% with high body mass index, 24.1% with low high-density lipoprotein cholesterol (HDL-C), and 12.1% with high triglycerides. Patients with at least two MS components had more night eating behaviors and tended to have lower percentage of slow-wave sleep and more fragmented sleep. On multiple sleep latency test, they had shorter mean sleep latencies to rapid eye movement (REM), non-REM sleep and tended to have more sleep onset REM periods (SOREMPs) than those with less than two MS components. CONCLUSIONS Insulin resistance was found to be the core metabolic disturbance in obese as well as in nonobese children with narcolepsy. Children with narcolepsy with at least two MS components presented a more severe daytime sleepiness and a higher prevalence of night-eating behaviors than those with less than two MS components. Such children might benefit from early evaluation and management in order to prevent future complications.
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Affiliation(s)
- Min Zhang
- Integrative Physiology of the Brain Arousal Systems, CRNL, INSERM U1028, CNRS UMR5292, University of Lyon 1, Lyon, France
| | - Marine Thieux
- Integrative Physiology of the Brain Arousal Systems, CRNL, INSERM U1028, CNRS UMR5292, University of Lyon 1, Lyon, France
- Pediatric Sleep Unit, Hôpital Femme Mère Enfant, Hospices Civils de Lyon and National Reference Center for Narcolepsy, University of Lyon1, Lyon, France
| | - Laura Arvis
- Pediatric endocrinology Unit, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Jian-Sheng Lin
- Integrative Physiology of the Brain Arousal Systems, CRNL, INSERM U1028, CNRS UMR5292, University of Lyon 1, Lyon, France
| | - Aurore Guyon
- Integrative Physiology of the Brain Arousal Systems, CRNL, INSERM U1028, CNRS UMR5292, University of Lyon 1, Lyon, France
- Pediatric Sleep Unit, Hôpital Femme Mère Enfant, Hospices Civils de Lyon and National Reference Center for Narcolepsy, University of Lyon1, Lyon, France
| | | | - Carine Villanueva
- Pediatric endocrinology Unit, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Patricia Franco
- Integrative Physiology of the Brain Arousal Systems, CRNL, INSERM U1028, CNRS UMR5292, University of Lyon 1, Lyon, France
- Pediatric Sleep Unit, Hôpital Femme Mère Enfant, Hospices Civils de Lyon and National Reference Center for Narcolepsy, University of Lyon1, Lyon, France
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6
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Casale S, Assirelli V, Pizza F, Balsamo A, Gennari M, Pession A, Plazzi G, Cassio A. Auxological and endocrine findings in narcolepsy type 1: seventeen-year follow-up from a pediatric endocrinology center. Front Endocrinol (Lausanne) 2023; 14:1037398. [PMID: 37396177 PMCID: PMC10311432 DOI: 10.3389/fendo.2023.1037398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 05/26/2023] [Indexed: 07/04/2023] Open
Abstract
Introduction Narcolepsy Type 1 (NT1) is a rare hypersomnia of central origin linked to hypocretin deficiency, most frequently arising at pediatric age. NT1 could be associated with endocrine comorbidities involving the neuroendocrine axis, predominantly obesity, and Central Precocious Puberty (CPP). The primary aim of this study is the evaluation of endocrine and auxological parameters at diagnosis and during follow-up in patients with NT1, treated with Sodium Oxybate (SO) or not. Methods We retrospectively evaluated the auxological, biochemical, and radiological parameters of 112 patients referred to our Center between 2004-2022. The design of our study is cross-sectional at the time of diagnosis followed by a longitudinal follow-up. Results Our study confirms an increased frequency of CPP and obesity in patients with NT1. At first evaluation, obesity was found in 31.3% of patients, while overweight was found in 25.0%. A diagnosis of CPP was made in 19.6% of patients. Interestingly, this group showed a significantly lower level of CSF-hypocretin (hrct-1) at diagnosis compared to others. We found an improvement in BMI SDS in the SO-treated group compared to untreated patients, and this trend persisted also at 36 months of follow-up (0.0 ± 1.3 vs 1.3 ± 0.4; p<0.03). Sixty-three patients reached their final height, with a median SDS of 0.6 ± 1.1 in boys and 0.2 ± 1.2 in girls. Discussion To our knowledge, these are the first results regarding the final height in a large series of pediatric patients with NT1, with a normal range of IGF1-SDS levels and stature SDS.
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Affiliation(s)
- Sara Casale
- Specialty School of Pediatrics, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Valentina Assirelli
- Specialty School of Pediatrics, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Fabio Pizza
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Antonio Balsamo
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Monia Gennari
- Pediatric Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Andrea Pession
- Pediatric Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), University of Bologna, Bologna, Italy
| | - Giuseppe Plazzi
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio-Emilia, Modena, Italy
| | - Alessandra Cassio
- Pediatric Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), University of Bologna, Bologna, Italy
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7
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Abad VC. Calcium, magnesium, potassium, and sodium oxybates oral solution for cataplexy or excessive daytime sleepiness associated with narcolepsy. Expert Opin Pharmacother 2023; 24:875-885. [PMID: 37060579 DOI: 10.1080/14656566.2023.2204187] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2023]
Abstract
INTRODUCTION Lower-sodium oxybate (LXB) is a novel formulation that is approved by the US Food and Drug Administration (FDA) to treat cataplexy and excessive daytime sleepiness (EDS) in adult patients and children ≥ 7 years with narcolepsy. LXB contains 92 percent less sodium than sodium oxybate (SXB), which adds 550-1640 mg of sodium/day at usual doses of 3-9 grams per day. The FDA has declared LXB to be clinically superior to SXB due to greater safety by reducing the chronic sodium load. Narcolepsy patients have high comorbidities for hypertension and cardiovascular disease, conditions which can be adversely affected by high sodium intake. AREAS COVERED This drug review discusses narcolepsy, current and upcoming pharmacotherapy, and LXB chemistry, pharmacodynamics, pharmacokinetics, and metabolism. Published results from LXB's phase 1 studies, a phase 3 study, and 2 post-marketing studies are reviewed. Databases searched included Pubmed, Google Scholar, Lexi-Comp, Scopus, Science, and Ovid. EXPERT OPINION LXB is efficacious in treating daytime sleepiness and cataplexy in adults and children ≥ 7 years with narcolepsy. Using LXB instead of SXB formulations may benefit narcolepsy patients with cardiovascular comorbidities and hypertension, but long-term studies are needed to prove it.
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Affiliation(s)
- Vivien C Abad
- Division of Sleep Medicine, Department of Psychiatry and Behavioral Sciences Stanford University, California, United States of America
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8
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Triller A, Pizza F, Lecendreux M, Lieberich L, Rezaei R, Pech de Laclause A, Vandi S, Plazzi G, Kallweit U. Real-world treatment of pediatric narcolepsy with pitolisant: A retrospective, multicenter study. Sleep Med 2023; 103:62-68. [PMID: 36758348 DOI: 10.1016/j.sleep.2023.01.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 01/11/2023] [Accepted: 01/20/2023] [Indexed: 01/26/2023]
Abstract
BACKGROUND First symptoms of narcolepsy mostly present during childhood. Pharmacological management options in children are limited, also due to approval status. Pitolisant is an inverse histamine 3 receptor agonist and has been approved for the treatment of adult narcolepsy with or without cataplexy by EMA and FDA. Clinical experience indicates for a beneficial use also in children and adolescents. Our goal was to evaluate the effects and tolerability of pitolisant in narcolepsy children/adolescents in a real-world setting. METHODS This multicentre retrospective observational study included 55 patients with narcolepsy from three international narcolepsy centers (Germany, France and Italy) who were treated with pitolisant. Patients were eligible if they were at least 6 years old and diagnosed with narcolepsy type 1 or 2. Demographic and clinical characteristics, questionnaires, sleep medicine and laboratory data were collected. RESULTS 55 children/adolescents (25 girls, 45.45%, 30 boys, 54.55%) aged 6-18 years, with narcolepsy (type 1 = 92.7%, type 2 = 7.3%), were treated with pitolisant. The mean pitolisant dose was 34.1 mg/d. Treatment was effective for excessive daytime sleepiness (EDS) and cataplexy: the pediatric Epworth Sleepiness Scale (ESS) score decreased from 19 to 13.5 (p < 0.001) and the weekly cataplexy frequency improved from 7.9 at baseline to 5.2 (p < 0.001). Treatment with pitolisant was well tolerated. Side effects were mild and mostly short-term. Insomnia was reported most frequently (5.5%). CONCLUSION First real-world results suggest that pitolisant treatment is effective in improving EDS and cataplexy in children with narcolepsy, and also is well tolerated.
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Affiliation(s)
- Annika Triller
- Center for Narcolepsy and Hypersomnias, Clinical Sleep and Neuroimmunology, Institute of Immunology, University of Witten/Herdecke, Witten, Germany
| | - Fabio Pizza
- Department of Biomedical Science and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy; IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Michel Lecendreux
- Pediatric Sleep Centre, Robert Debre Hospital, Paris, France; Reference Center for Narcolepsy and Hypersomnias, Robert Debre Hospital, Paris, France
| | - Lea Lieberich
- Center for Narcolepsy and Hypersomnias, Clinical Sleep and Neuroimmunology, Institute of Immunology, University of Witten/Herdecke, Witten, Germany
| | - Rana Rezaei
- Center for Narcolepsy and Hypersomnias, Clinical Sleep and Neuroimmunology, Institute of Immunology, University of Witten/Herdecke, Witten, Germany
| | - Anna Pech de Laclause
- Pediatric Sleep Centre, Robert Debre Hospital, Paris, France; Reference Center for Narcolepsy and Hypersomnias, Robert Debre Hospital, Paris, France
| | - Stefano Vandi
- Department of Biomedical Science and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy; IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Giuseppe Plazzi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy; Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Ulf Kallweit
- Center for Narcolepsy and Hypersomnias, Clinical Sleep and Neuroimmunology, Institute of Immunology, University of Witten/Herdecke, Witten, Germany.
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9
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Dhafar HO, BaHammam AS. Body Weight and Metabolic Rate Changes in Narcolepsy: Current Knowledge and Future Directions. Metabolites 2022; 12:1120. [PMID: 36422261 PMCID: PMC9693066 DOI: 10.3390/metabo12111120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 11/13/2022] [Accepted: 11/15/2022] [Indexed: 08/26/2023] Open
Abstract
Narcolepsy is a known auto-immune disease that presents mainly in the teenage years with irresistible sleep attacks. Patients with narcolepsy, especially NT1, have been found to have a high prevalence of obesity and other metabolic derangements. This narrative review aimed to address the relationship between narcolepsy and changes in weight and metabolic rate, and discuss potential mechanisms for weight gain and metabolic changes and future research agendas on this topic. This article will provide a balanced, up-to-date critical review of the current literature, and delineate areas for future research, in order to understand the pathophysiological metabolic changes in narcolepsy. Articles using predefined keywords were searched for in PubMed and Google Scholar databases, with predefined inclusion and exclusion criteria. Compared to controls, patients with narcolepsy are more likely to be obese and have higher BMIs and waist circumferences. According to recent research, weight gain in narcolepsy patients may be higher during the disease's outset. The precise mechanisms causing this weight gain remains unknown. The available information, albeit limited, does not support differences in basal or resting metabolic rates between patients with narcolepsy and controls, other than during the time of disease onset. The evidence supporting the role of orexin in weight gain in humans with narcolepsy is still controversial, in the literature. Furthermore, the available data did not show any appreciable alterations in the levels of CSF melanin-concentrating hormone, plasma and CSF leptin, or serum growth hormone, in relation to weight gain. Other mechanisms have been proposed, including a reduction in sympathetic tone, hormonal changes, changes in eating behavior and physical activity, and genetic predisposition. The association between increased body mass index and narcolepsy is well-recognized; however, the relationship between narcolepsy and other metabolic measures, such as body fat/muscle distribution and metabolic rate independent of BMI, is not well documented, and the available evidence is inconsistent. Future longitudinal studies with larger sample sizes are needed to assess BMR in patients with narcolepsy under a standard protocol at the outset of narcolepsy, with regular follow-up.
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Affiliation(s)
- Hamza O. Dhafar
- The University Sleep Disorders Center, Department of Medicine, College of Medicine, King Saud University, Riyadh 11451, Saudi Arabia
- Department of Family Medicine, Prince Mansour Military Hospital, Taif 26526, Saudi Arabia
| | - Ahmed S. BaHammam
- The University Sleep Disorders Center, Department of Medicine, College of Medicine, King Saud University, Riyadh 11451, Saudi Arabia
- The Strategic Technologies Program of the National Plan for Sciences and Technology and Innovation in the Kingdom of Saudi Arabia, P.O. Box 2454, Riyadh 11324, Saudi Arabia
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10
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Precocious puberty in narcolepsy type 1: Orexin loss and/or neuroinflammation, which is to blame? Sleep Med Rev 2022; 65:101683. [PMID: 36096986 DOI: 10.1016/j.smrv.2022.101683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 07/20/2022] [Accepted: 07/25/2022] [Indexed: 10/14/2022]
Abstract
Narcolepsy type 1 (NT1) is a rare neurological sleep disorder triggered by postnatal loss of the orexin/hypocretin neuropeptides. Overweight/obesity and precocious puberty are highly prevalent comorbidities of NT1, with a close temporal correlation with disease onset, suggesting a common origin. However, the underlying mechanisms remain unknown and merit further investigation. The main question we address in this review is whether the occurrence of precocious puberty in NT1 is due to the lack of orexin/hypocretin or rather to a wider hypothalamic dysfunction in the context of neuroinflammation, which is likely to accompany the disease given its autoimmune origins. Our analysis suggests that the suspected generalized neuroinflammation of the hypothalamus in NT1 would tend to delay puberty rather than hastening it. In contrast, that the brutal loss of orexin/hypocretin would favor an early reactivation of gonadotropin-releasing hormone (GnRH) secretion during the prepubertal period in vulnerable children, leading to early puberty onset. Orexin/hypocretin replacement could thus be envisaged as a potential treatment for precocious puberty in NT1. Additionally, we put forward an alternative hypothesis regarding the concomitant occurrence of sleepiness, weight gain and early puberty in NT1.
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11
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Lecendreux M, Plazzi G, Dauvilliers Y, Rosen CL, Ruoff C, Black J, Parvataneni R, Guinta D, Wang YG, Mignot E. Long-term safety and maintenance of efficacy of sodium oxybate in the treatment of narcolepsy with cataplexy in pediatric patients. J Clin Sleep Med 2022; 18:2217-2227. [PMID: 35689598 PMCID: PMC9435339 DOI: 10.5664/jcsm.10090] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 04/22/2022] [Accepted: 04/22/2022] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Evaluate long-term efficacy and safety of sodium oxybate (SXB) in children and adolescents (aged 7-16 years) with narcolepsy with cataplexy. METHODS A double-blind randomized withdrawal study was conducted. Prior to randomization, SXB-naive participants were titrated to an efficacious and tolerable dose of SXB; participants taking SXB entered on their established dose. Following a 2-week stable-dose period and 2-week, double-blind, randomized withdrawal period, participants entered an open-label period (OLP; ≤ 47 weeks). Efficacy measures during the OLP included number of weekly cataplexy attacks, cataplexy-free days, and Epworth Sleepiness Scale for Children and Adolescents (ESS-CHAD). Safety outcomes included treatment-emergent adverse events; assessments of depression, anxiety, and suicidality; and polysomnography. RESULTS Of 106 enrolled participants, 95 entered and 85 completed the OLP. In SXB-naive participants and participants previously taking SXB, efficacy of SXB established prior to the double-blind, randomized withdrawal period was maintained throughout the OLP for number of weekly cataplexy attacks (median [quartile 1, quartile 3] change from the stable-dose period to end of the OLP: 0.0 [-2.5, 4.9] and 0.0 [-3.4, 2.6], respectively) and ESS-CHAD scores (0.0 [-3.0, 2.5] and 1.0 [-3.0, 3.0], respectively). The median (quartile 1, quartile 3) number of cataplexy-free days per week was 2.3 (0.0, 6.0) in OLP week 1 and 3.8 (0.5, 5.5) in week 48. Treatment-emergent adverse events (≥ 5%) were enuresis, nausea, vomiting, headache, decreased weight, decreased appetite, nasopharyngitis, upper respiratory tract infection, and dizziness. CONCLUSIONS SXB demonstrated long-term maintenance of efficacy in pediatric narcolepsy with cataplexy, with a safety profile consistent with that observed in adults. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Name: A Multicenter Study of the Efficacy and Safety of Xyrem with an Open-Label Pharmacokinetic Evaluation and Safety Extension in Pediatric Subjects with Narcolepsy with Cataplexy; URL: https://clinicaltrials.gov/ct2/show/NCT02221869; Identifier: NCT02221869. CITATION Lecendreux M, Plazzi G, Dauvilliers Y, et al. Long-term safety and maintenance of efficacy of sodium oxybate in the treatment of narcolepsy with cataplexy in pediatric patients. J Clin Sleep Med. 2022;18(9):2217-2227.
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Affiliation(s)
- Michel Lecendreux
- AP-HP, Pediatric Sleep Center, Hospital Robert-Debré, Paris, France
- National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic Hypersomnia, and Kleine-Levin Syndrome (CNR Narcolepsie-Hypersomnie), Paris, France
- INSERM CIC1426, Paris, France
| | - Giuseppe Plazzi
- Department of Biomedical, Metabolic, and Neural Sciences, University of Modena and Reggio-Emilia, Modena, Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Yves Dauvilliers
- Sleep and Wake Disorders Centre, Department of Neurology, Gui de Chauliac Hospital, Montpellier, France
- University of Montpellier, INSERM Institute Neuroscience Montpellier (INM), Montpellier, France
| | - Carol L. Rosen
- Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Chad Ruoff
- Stanford Sleep Medicine Center, Redwood City, California
- Division of Pulmonary Medicine, Center for Sleep Medicine, Mayo Clinic in Arizona, Scottsdale, Arizona
| | - Jed Black
- Stanford University Center for Sleep Sciences and Medicine, Palo Alto, California
- Jazz Pharmaceuticals, Palo Alto, California
| | | | | | | | - Emmanuel Mignot
- Stanford University Center for Sleep Sciences and Medicine, Palo Alto, California
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12
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Dye TJ, Simakajornboon N. Narcolepsy in Children: Sleep disorders in children, A rapidly evolving field seeking consensus. Pediatr Pulmonol 2022; 57:1952-1962. [PMID: 34021733 DOI: 10.1002/ppul.25512] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 05/16/2021] [Accepted: 05/17/2021] [Indexed: 11/09/2022]
Abstract
Narcolepsy is a life-long sleep disorder with two distinct subtypes, narcolepsy type I and narcolepsy type II. It is now well recognized that the loss of hypocretin neurons underlies the pathogenesis of narcolepsy type I, however, the pathogenesis of narcolepsy type II is currently unknown. Both genetic and environmental factors play an important role in the pathogenesis of narcolepsy. There is increasing evidence that autoimmune processes may play a critical role in the loss of hypocretin neurons. Infections especially streptococcus and influenza have been proposed as a potential trigger for the autoimmune-mediated mechanism. Several recent studies have shown increased cases of pediatric narcolepsy following the 2009 H1N1 pandemic. The increased cases in Europe seem to be related to a specific type of H1N1 influenza vaccination (Pandemrix), while the increased cases in China are related to influenza infection. Children with narcolepsy can have an unusual presentation at disease onset including complex motor movements which may lead to delayed diagnosis. All classic narcolepsy tetrads are present in only a small proportion of children. The diagnosis of narcolepsy is confirmed by either obtaining cerebrospinal fluid hypocretin or overnight sleep study with the multiple sleep latency test (MSLT). There are limitations of using MSLT in young children such that a negative MSLT test cannot exclude narcolepsy. HLA markers have limited utility in narcolepsy, but it may be useful in young children with clinical suspicion of narcolepsy. For management, both pharmacologic and non-pharmacologic treatments are important in the management of narcolepsy. Pharmacotherapy is primarily aimed to address excessive daytime sleepiness and REM-related symptoms such as cataplexy. In addition to pharmacotherapy, routine screening of behavioral and psychosocial issues is warranted to identify patients who would benefit from bio-behavior intervention.
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Affiliation(s)
- Thomas J Dye
- Division of Pulmonary and Sleep Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Narong Simakajornboon
- Division of Pulmonary and Sleep Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Honda M, Shigematsu Y, Shimada M, Honda Y, Tokunaga K, Miyagawa T. Low carnitine palmitoyltransferase 1 activity is a risk factor for narcolepsy type 1 and other hypersomnia. Sleep 2022; 45:6639424. [DOI: 10.1093/sleep/zsac160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 06/06/2022] [Indexed: 12/13/2022] Open
Abstract
Abstract
Study Objectives
Narcolepsy type 1 (NT1) is associated with metabolic abnormalities but their etiology remains largely unknown. The gene for carnitine palmitoyltransferase 1B (CPT1B) and abnormally low serum acylcarnitine levels have been linked to NT1. To elucidate the details of altered fatty acid metabolism, we determined levels of individual acylcarnitines and evaluated CPT1 activity in patients with NT1 and other hypersomnia.
Methods
Blood samples from 57 NT1, 51 other hypersomnia patients, and 61 healthy controls were analyzed. The levels of 25 major individual acylcarnitines were determined and the C0/(t[C16] + t[C18]) ratio was used as a CPT1 activity marker. We further performed transcriptome analysis using independent blood samples from 42 NT1 and 42 healthy controls to study the relevance of fatty acid metabolism. NT1-specific changes in CPT1 activity and in expression of related genes were investigated.
Results
CPT1 activity was lower in patients with NT1 (p = 0.00064) and other hypersomnia (p = 0.0014) than in controls. Regression analysis revealed that CPT1 activity was an independent risk factor for NT1 (OR: 1.68; p = 0.0031) and for other hypersomnia (OR: 1.64; p = 0.0042). There was a significant interaction between obesity (BMI <25, ≥25) and the SNP rs5770917 status such that nonobese NT1 patients without risk allele had better CPT1 activity (p = 0.0089). The expression levels of carnitine-acylcarnitine translocase (CACT) and CPT2 in carnitine shuttle were lower in NT1 (p = 0.000051 and p = 0.00014, respectively).
Conclusions
These results provide evidences that abnormal fatty acid metabolism is involved in the pathophysiology of NT1 and other hypersomnia.
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Affiliation(s)
- Makoto Honda
- Sleep Disorders Project, Department of Psychiatry and Behavioral Sciences, Tokyo Metropolitan Institute of Medical Science , Tokyo , Japan
- Japan Somnology Center and Seiwa Hospital, Institute of Neuropsychiatry , Tokyo , Japan
| | - Yosuke Shigematsu
- Department of Health Science, Faculty of Medical Sciences, University of Fukui , Fukui , Japan
| | - Mihoko Shimada
- Sleep Disorders Project, Department of Psychiatry and Behavioral Sciences, Tokyo Metropolitan Institute of Medical Science , Tokyo , Japan
- Department of Human Genetics, Graduate School of Medicine, The University of Tokyo , Tokyo , Japan
- Genome Medical Science Project (Toyama), National Center for Global Health and Medicine , Tokyo , Japan
| | - Yoshiko Honda
- Sleep Disorders Project, Department of Psychiatry and Behavioral Sciences, Tokyo Metropolitan Institute of Medical Science , Tokyo , Japan
| | - Katsushi Tokunaga
- Department of Human Genetics, Graduate School of Medicine, The University of Tokyo , Tokyo , Japan
- Genome Medical Science Project (Toyama), National Center for Global Health and Medicine , Tokyo , Japan
| | - Taku Miyagawa
- Sleep Disorders Project, Department of Psychiatry and Behavioral Sciences, Tokyo Metropolitan Institute of Medical Science , Tokyo , Japan
- Department of Human Genetics, Graduate School of Medicine, The University of Tokyo , Tokyo , Japan
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Zhang M, Thieux M, Inocente CO, Vieux N, Arvis L, Villanueva C, Lin JS, Plancoulaine S, Guyon A, Franco P. Characterization of rapid weight gain phenotype in children with narcolepsy. CNS Neurosci Ther 2022; 28:829-841. [PMID: 35212159 PMCID: PMC9062543 DOI: 10.1111/cns.13811] [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] [Received: 10/16/2021] [Revised: 01/20/2022] [Accepted: 01/21/2022] [Indexed: 12/03/2022] Open
Abstract
Objectives To characterize the rapid weight gain (RWG) phenotype associated with the onset of childhood narcolepsy and to determine whether it could constitute a marker of severity of the disease. Methods RWG was defined using the BMI z‐score slope reported to one year (>0.67 SD) from symptom onset to disease diagnosis. We compared the clinical, metabolic, and sleep characteristics between patients with or without RWG at diagnosis. Pharmacological management, anthropometric, and clinical progression were also evaluated during the follow‐up. Results A total of 84 de novo narcoleptic pediatric patients were included; their median age at diagnosis was 12.0 years; 59.5% boys, 90.5% cataplexy, and 98.7% HLA‐DQB1*06:02, 57% had RWG profile. RWG patients were younger at diagnosis than non‐RWG patients, despite a shorter diagnostic delay. They had a higher BMI z‐score and a higher prevalence of obesity at diagnosis, but not at symptom onset, and higher adapted Epworth Sleepiness Scale and Insomnia Severity Index scores than non‐RWG patients. No differences on nocturnal polysomnography and multiple sleep latency tests were found between groups at disease diagnosis. After a median follow‐up of 5 years, RWG patients still had a higher BMI z‐score and a higher prevalence of obesity despite benefiting from the same therapeutic management and displaying improvement in sleepiness and school difficulties. Conclusions Narcoleptic RWG patients were younger, sleepier, and the prevalence of obesity was higher at diagnosis despite a shorter diagnostic delay than that of non‐RWG patients. These patients had also a higher risk of developing a long‐term obesity, despite a positive progression of their narcoleptic symptoms. RGW could then represent a maker of a more severe phenotype of childhood narcolepsy, which should inspire a prompt and more offensive management to prevent obesity and its complications.
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Affiliation(s)
- Min Zhang
- Integrative Physiology of the Brain Arousal Systems, CRNL, INSERM U1028, CNRS UMR5292, Université Claude Bernard Lyon 1, Lyon, France
| | - Marine Thieux
- Integrative Physiology of the Brain Arousal Systems, CRNL, INSERM U1028, CNRS UMR5292, Université Claude Bernard Lyon 1, Lyon, France.,Pediatric Sleep Unit, Hôpital Femme Mère Enfant, Hospices Civils de Lyon & National Reference Center for Narcolepsy, Université Claude Bernard Lyon 1, Lyon, France
| | - Clara Odilia Inocente
- Integrative Physiology of the Brain Arousal Systems, CRNL, INSERM U1028, CNRS UMR5292, Université Claude Bernard Lyon 1, Lyon, France
| | - Noemie Vieux
- Pediatric Sleep Unit, Hôpital Femme Mère Enfant, Hospices Civils de Lyon & National Reference Center for Narcolepsy, Université Claude Bernard Lyon 1, Lyon, France
| | - Laura Arvis
- Pediatric Endocrinology Unit, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Carine Villanueva
- Pediatric Endocrinology Unit, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Jian-Sheng Lin
- Integrative Physiology of the Brain Arousal Systems, CRNL, INSERM U1028, CNRS UMR5292, Université Claude Bernard Lyon 1, Lyon, France
| | | | - Aurore Guyon
- Pediatric Sleep Unit, Hôpital Femme Mère Enfant, Hospices Civils de Lyon & National Reference Center for Narcolepsy, Université Claude Bernard Lyon 1, Lyon, France
| | - Patricia Franco
- Integrative Physiology of the Brain Arousal Systems, CRNL, INSERM U1028, CNRS UMR5292, Université Claude Bernard Lyon 1, Lyon, France.,Pediatric Sleep Unit, Hôpital Femme Mère Enfant, Hospices Civils de Lyon & National Reference Center for Narcolepsy, Université Claude Bernard Lyon 1, Lyon, France
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15
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Futenma K, Takaesu Y, Nakamura M, Hayashida K, Takeuchi N, Inoue Y. Metabolic-Syndrome-Related Comorbidities in Narcolepsy Spectrum Disorders: A Preliminary Cross-Sectional Study in Japan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19106285. [PMID: 35627822 PMCID: PMC9141676 DOI: 10.3390/ijerph19106285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 05/20/2022] [Accepted: 05/21/2022] [Indexed: 11/17/2022]
Abstract
Narcolepsy types 1 (NT1) and 2 (NT2) and idiopathic hypersomnia (IH) are thought to be a disease continuum known as narcolepsy spectrum disorders (NSDs). This study aimed to assess the prevalence of and factors associated with metabolic-syndrome-related disorders (MRDs) among patients with NSD. Japanese patients with NSD (NT1, n = 94; NT2, n = 83; and IH, n = 57) aged ≥35 years were enrolled in this cross-sectional study. MRD was defined as having at least one of the following conditions: hypertension, diabetes, or dyslipidemia. Demographic variables and MRD incidence were compared among patients in the respective NSD categories. Multivariate logistic regression analysis was used to investigate the factors associated with MRDs. Patients with NT1 had a higher body mass index (BMI) and incidence of MRD than that had by those with NT2 or IH. Age, BMI, and the presence of OSA were significantly associated with the incidence of MRD in NSDs. Age and BMI in NT1, BMI and human leukocyte antigen (HLA)-DQB1*06:02 positivity in NT2, and only age in IH were factors associated with the incidence of MRD. Obesity should be carefully monitored in narcolepsy; however, NT2 with HLA-DQB1*06:02 positive should be followed up for the development of MRD even without obesity.
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Affiliation(s)
- Kunihiro Futenma
- Department of Neuropsychiatry, Graduate School of Medicine, University of the Ryukyus, 207, Uehara, Nishihara-cho, Nakagami-gun, Okinawa 903-0215, Japan;
- Japan Somnology Center, Neuropsychiatric Research Institute, 5-10-10, Yoyogi, Shinjuku-ku, Tokyo 151-0053, Japan; (M.N.); (N.T.)
- Correspondence: (K.F.); (Y.I.); Tel.: +81-98-895-1157 (K.F.); +81-3-6804-8995 (Y.I.)
| | - Yoshikazu Takaesu
- Department of Neuropsychiatry, Graduate School of Medicine, University of the Ryukyus, 207, Uehara, Nishihara-cho, Nakagami-gun, Okinawa 903-0215, Japan;
- Japan Somnology Center, Neuropsychiatric Research Institute, 5-10-10, Yoyogi, Shinjuku-ku, Tokyo 151-0053, Japan; (M.N.); (N.T.)
| | - Masaki Nakamura
- Japan Somnology Center, Neuropsychiatric Research Institute, 5-10-10, Yoyogi, Shinjuku-ku, Tokyo 151-0053, Japan; (M.N.); (N.T.)
- Department of Somnology, Tokyo Medical University, 6-7-1, Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan
- Aoyama-Omotesando Sleep Stress Clinic, Aoyama Rise Square 3F, 5-1-22 Minamiaoyama, Minato-ku, Tokyo 107-0062, Japan
| | - Kenichi Hayashida
- Sleep Support Clinic, Miranbeena 1F, 1-18-8 Higashioi, Shinagawa-Ku, Tokyo 140-0011, Japan;
| | - Noboru Takeuchi
- Japan Somnology Center, Neuropsychiatric Research Institute, 5-10-10, Yoyogi, Shinjuku-ku, Tokyo 151-0053, Japan; (M.N.); (N.T.)
- Department of Somnology, Tokyo Medical University, 6-7-1, Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan
- Department of Neuropsychiatry, Kurume University School of Medicine, 67 Asahi-machi, Kurume 830-0011, Japan
| | - Yuichi Inoue
- Japan Somnology Center, Neuropsychiatric Research Institute, 5-10-10, Yoyogi, Shinjuku-ku, Tokyo 151-0053, Japan; (M.N.); (N.T.)
- Department of Somnology, Tokyo Medical University, 6-7-1, Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan
- Correspondence: (K.F.); (Y.I.); Tel.: +81-98-895-1157 (K.F.); +81-3-6804-8995 (Y.I.)
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16
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Veneruso M, Pizza F, Finotti E, Amore G, Vandi S, Filardi M, Antelmi E, Nobili L, Cassio A, Pession A, Plazzi G. Child Neurology: A Case Series of Heterogeneous Neuropsychiatric Symptoms and Outcome in Very Early-Onset Narcolepsy Type 1. Neurology 2022; 98:984-989. [PMID: 35387850 DOI: 10.1212/wnl.0000000000200666] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 03/16/2022] [Indexed: 11/15/2022] Open
Abstract
Narcolepsy type 1 is a central disorder of hypersomnolence characterized by excessive daytime sleepiness, cataplexy (i.e., sudden loss of muscle tone during wakefulness triggered by emotions), and rapid eye movement sleep-related manifestations that can present with a peculiar phenotype when arising at a pediatric age. Several features of childhood-onset narcolepsy type 1 are also common in neuropsychiatric conditions; discrete neuropsychiatric comorbidity has also been demonstrated.Here we report on three children with very early narcolepsy type 1. All three patients had psychiatric features at time of symptom onset coupled with peculiar motor disturbances. The course of narcolepsy symptoms also paralleled neuropsychiatric symptoms, suggesting a possible intrinsic link between sleep and psychological features.Multidisciplinary management is mandatory for pediatric narcolepsy type 1 since prompt disease management addressing neuropsychiatric symptoms could lead to better clinical outcomes and quality of life.
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Affiliation(s)
- Marco Veneruso
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Fabio Pizza
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Elena Finotti
- Department of Rehabilitation, Child and Adolescent Neuropsychiatry Unit, ULSS 6, Vicenza, Italy
| | - Giulia Amore
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Stefano Vandi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Marco Filardi
- Department of Basic Medicine, Neuroscience and Sense Organs, University Aldo Moro Bari, Bari, Italy.,Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro -A.O. Pia Fondazione Cardinale G. Panico, Tricase, Italy
| | - Elena Antelmi
- Neurology Unit, Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Lino Nobili
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy.,Child Neuropsychiatry Unit, IRCCS Istituto G. Gaslini, Genova, Italy
| | - Alessandra Cassio
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.,IRCCS S.Orsola-Malpighi Hospital, Bologna, Italy
| | - Andrea Pession
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.,IRCCS S.Orsola-Malpighi Hospital, Bologna, Italy
| | - Giuseppe Plazzi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.,Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
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17
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The REM-sleep related characteristics of narcolepsy: A nation-wide multi-center study in Turkey, the REMCON study. Sleep Med 2022; 94:17-25. [DOI: 10.1016/j.sleep.2022.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 03/22/2022] [Accepted: 03/27/2022] [Indexed: 11/18/2022]
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18
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The role of mtDNA haplogroups on metabolic features in narcolepsy type 1. Mitochondrion 2022; 63:37-42. [PMID: 35051655 DOI: 10.1016/j.mito.2022.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 01/09/2022] [Accepted: 01/12/2022] [Indexed: 11/24/2022]
Abstract
Narcolepsy type 1 (NT1) is due to selective loss of hypocretin (hcrt)-producing-neurons. Hcrt is a neuropeptide regulating the sleep/wake cycle, as well as feeding behavior. A subset of NT1 patients become overweight/obese, with a dysmetabolic phenotype. We hypothesized that mitochondrial DNA (mtDNA) sequence variation might contribute to the metabolic features in NT1 and we undertook an exploratory survey of mtDNA haplogroups in a cohort of well-characterized patients. We studied 246 NT1 Italian patients, fully defined for their metabolic features, including obesity, hypertension, low HDL, hypertriglyceridemia and hyperglycemia. For haplogroup assignment, the mtDNA control region was sequenced in combination with an assessment of diagnostic markers in the coding region. NT1 patients displayed the same mtDNA haplogroups (H, HV, J, K, T, U) frequency as those reported in the general Italian population. The majority of NT1 patients (64%) were overweight: amongst these, 35% were obese, 48% had low HDL cholesterol levels, and 31% had hypertriglyceridemia. We identified an association between haplogroups J, K and hypertriglyceridemia (P=0.03, 61.5% and 61.5%, respectively vs. 31.3% of the whole sample) and after correction for age and sex, we observed a reduction of these associations (OR=3.65, 95%CI=0.76-17.5, p=0.106 and 1.73, 0.52-5.69, p=0.368, respectively). The low HDL level showed a trend for association with haplogroup J (P=0.09, 83.3% vs. 47.4% of the whole sample) and after correction we observed an OR=6.73, 95%CI=0.65-69.9, p=0.110. Our study provides the first indication that mtDNA haplogroups J and K can modulate metabolic features of NT1 patients, linking mtDNA variation to the dysmetabolic phenotype in NT1.
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19
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Ponziani V, Pizza F, Zenesini C, Vignatelli L, Pession A, Plazzi G. BMI changes in pediatric type 1 narcolepsy under sodium oxybate treatment. Sleep 2021; 44:6060056. [PMID: 33388769 DOI: 10.1093/sleep/zsaa295] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 12/23/2020] [Indexed: 12/12/2022] Open
Abstract
Pediatric type 1 narcolepsy (NT1) is often associated with overweight and obesity. Sodium oxybate (SO), approved for the treatment of narcolepsy with cataplexy from the age of 7 years old in the United States, has been associated with weight loss, although longitudinal pediatric studies are lacking. We report a retrospective cohort of 129 consecutive patients with a 4-year follow-up, to analyze the impact of different pharmacological treatments on body mass index (BMI) z-score. At baseline, the prevalence of obesity and overweight was 26.4% (34/129) and 29.5% (38/129), respectively. Patients were divided into three groups: children treated with SO alone (group 1), with SO-combined therapy (group 2), and without SO (group 3). At the end of the first year of follow-up, group 1 and group 2 showed a significant BMI z-score reduction compared to baseline: from 1.2 ± 1.1 to 0.4 ± 1.4 for group 1 (p < 0.001), and from 1.4 ± 1.1 to 1 ± 1.3 for group 2 (p = 0.002), independently from baseline clinical features. In the second year, only group 2 experienced a further and significant BMI z-score decrease (from 1.0 ± 1.2 to 0.6 ± 1.2, p = 0.037). No further significant BMI z-score changes were observed in SO-treated patients in the following years. Instead, children treated without SO developed a significant weight increase between the second and third year of therapy (BMI z-score from 0.3 ± 0.9 to 0.5 ± 0.9). In conclusion, SO treatment in pediatric NT1 is associated with a favorable weight reduction in the first year of treatment.
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Affiliation(s)
- Virginia Ponziani
- Department of Pediatrics, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Fabio Pizza
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy
| | | | | | - Andrea Pession
- Department of Pediatrics, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Giuseppe Plazzi
- IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy.,Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
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20
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Lucien JN, Ortega MT, Shaw ND. Sleep and Puberty. CURRENT OPINION IN ENDOCRINE AND METABOLIC RESEARCH 2021; 17:1-7. [PMID: 35005296 PMCID: PMC8730357 DOI: 10.1016/j.coemr.2020.09.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
In the 1970's, Boyar and colleagues made the seminal observation that during the early stages of puberty, there is a sleep-specific augmentation of pulsatile luteinizing hormone (LH) secretion. Building on this tantalizing association between sleep and the re-awakening of the neuro-reproductive axis, a number of investigators have since mapped the dynamic relationship between sleep and reproductive hormones across the pubertal transition. In this review, we focus on the complex, reciprocal relationship between sleep and reproductive hormones during adolescence as well as the potential effects of melatonin and orexin on gonadotropin-releasing hormone (GnRH) activity in children with chronic insomnia and narcolepsy, respectively. Given the important interaction between the reproductive and somatotropic axes during puberty, we end with a discussion of sleep and growth hormone (GH) secretion in children.
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Affiliation(s)
- Janet N Lucien
- Pediatric Neuroendocrinology Group, Clinical Research Branch, National Institute of Environmental Health Sciences (NIEHS/NIH), Research Triangle Park, NC 27709
| | - Madison T Ortega
- Pediatric Neuroendocrinology Group, Clinical Research Branch, National Institute of Environmental Health Sciences (NIEHS/NIH), Research Triangle Park, NC 27709
| | - Natalie D Shaw
- Pediatric Neuroendocrinology Group, Clinical Research Branch, National Institute of Environmental Health Sciences (NIEHS/NIH), Research Triangle Park, NC 27709
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21
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Filardi M, Blunda V, Vandi S, Musetti A, Posar A, Visconti P, Pizza F, Plazzi G, Franceschini C. Case Report: Burden of Illness in Narcolepsy Type 1: Hikikomori in a Teenage Girl. Front Psychol 2021; 12:634941. [PMID: 33776861 PMCID: PMC7995606 DOI: 10.3389/fpsyg.2021.634941] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 02/12/2021] [Indexed: 12/01/2022] Open
Abstract
Narcolepsy type 1 (NT1) deeply impacts on quality of life, especially during adolescence, with NT1 children and adolescents that frequently report difficulties in integration with peers and decreased participation in after-school activities. Here we describe the case of NT1 teenager girl presenting with severe physical and social withdrawal, fulfilling the proposed diagnostic criteria for hikikomori, together with the classic NT1 symptoms. Social withdrawal is an overlooked phenomenon among NT1 children and adolescents that, if present, require a multidisciplinary approach and personalized interventions, but patients can benefit from NT1 pharmacological treatment.
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Affiliation(s)
- Marco Filardi
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Vincenza Blunda
- Istituto Di Ricovero e Cura a Carattere Scientifico, Istituto delle Scienze Neurologiche di Bologna, Unità Operativa Semplice d'Istituto Disturbi dello Spettro Autistico, Bologna, Italy
| | - Stefano Vandi
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
- Istituto Di Ricovero e Cura a Carattere Scientifico, Istituto delle Scienze Neurologiche di Bologna, Unita Operativa Complessa Clinica Neurologica, Bologna, Italy
| | - Alessandro Musetti
- Department of Humanities, Social Sciences and Cultural Industries, University of Parma, Parma, Italy
| | - Annio Posar
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
- Istituto Di Ricovero e Cura a Carattere Scientifico, Istituto delle Scienze Neurologiche di Bologna, Unità Operativa Semplice d'Istituto Disturbi dello Spettro Autistico, Bologna, Italy
| | - Paola Visconti
- Istituto Di Ricovero e Cura a Carattere Scientifico, Istituto delle Scienze Neurologiche di Bologna, Unità Operativa Semplice d'Istituto Disturbi dello Spettro Autistico, Bologna, Italy
| | - Fabio Pizza
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
- Istituto Di Ricovero e Cura a Carattere Scientifico, Istituto delle Scienze Neurologiche di Bologna, Unita Operativa Complessa Clinica Neurologica, Bologna, Italy
| | - Giuseppe Plazzi
- Istituto Di Ricovero e Cura a Carattere Scientifico, Istituto delle Scienze Neurologiche di Bologna, Unita Operativa Complessa Clinica Neurologica, Bologna, Italy
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
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22
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Coffey AA, Joyal AA, Yamanaka A, Scammell TE. The Impacts of Age and Sex in a Mouse Model of Childhood Narcolepsy. Front Neurosci 2021; 15:644757. [PMID: 33746708 PMCID: PMC7969886 DOI: 10.3389/fnins.2021.644757] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 02/12/2021] [Indexed: 11/13/2022] Open
Abstract
Narcolepsy is a sleep disorder caused by selective death of the orexin neurons that often begins in childhood. Orexin neuron loss disinhibits REM sleep during the active period and produces cataplexy, episodes of paralysis during wakefulness. Cataplexy is often worse when narcolepsy develops in children compared to adults, but the reason for this difference remains unknown. We used orexin-tTA; TetO DTA mice to model narcolepsy at different ages. When doxycycline is removed from the diet, the orexin neurons of these mice express diphtheria toxin A and die within 2-3 weeks. We removed doxycycline at 4 weeks (young-onset) or 14 weeks (adult-onset) of age in male and female mice. We implanted electroencephalography (EEG) and electromyography (EMG) electrodes for sleep recordings two weeks later and then recorded EEG/EMG/video for 24 h at 3 and 13 weeks after removal of doxycycline. Age-matched controls had access to doxycycline diet for the entire experiment. Three weeks after doxycycline removal, both young-onset and adult-onset mice developed severe cataplexy and the sleep-wake fragmentation characteristic of narcolepsy. Cataplexy and maintenance of wake were no worse in young-onset compared to adult-onset mice, but female mice had more bouts of cataplexy than males. Orexin neuron loss was similarly rapid in both young- and adult-onset mice. As age of orexin neuron loss does not impact the severity of narcolepsy symptoms in mice, the worse symptoms in children with narcolepsy may be due to more rapid orexin neuron loss than in adults.
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Affiliation(s)
- Alissa A. Coffey
- Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States
| | - Adam A. Joyal
- Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States
| | - Akihiro Yamanaka
- Department of Neuroscience II, Research Institute of Environmental Medicine, Nagoya University, Nagoya, Japan
| | - Thomas E. Scammell
- Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States
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23
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Mohammadi S, Moosaie F, Saghazadeh A, Mahmoudi M, Rezaei N. Metabolic profile in patients with narcolepsy: a systematic review and meta-analysis. Sleep Med 2021; 81:268-284. [PMID: 33740593 DOI: 10.1016/j.sleep.2021.02.040] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 02/10/2021] [Accepted: 02/16/2021] [Indexed: 11/25/2022]
Abstract
Narcolepsy, a sleep disorder characterized by loss of hypocretin neurons, has been associated with metabolic disturbances. Although the metabolic alterations in narcolepsy patients are widely investigated in the literature, the results are controversial. We performed a systematic search of literature to identify metabolic profiling studies in narcolepsy patients. A total of 48 studies were included in the meta-analysis. Narcolepsy patients exhibited higher prevalence of obesity (log OR = 0.93 [0.73-1.13], P < 0.001), diabetes mellitus (log OR = 0.64 [0.34, 0.94], P < 0.001), hypertension (log OR = 0.33 [0.11, 0.55], P < 0.001), and dyslipidemia (log OR = 1.19 [0.60, 1.77], P < 0.001) compared with non-narcoleptic controls. Narcolepsy was associated with higher BMI (SMD = 0.50 [0.32-0.68], P < 0.001), waist circumference (MD = 8.61 [2.03-15.19], P = 0.01), and plasma insulin (SMD = 0.61 [0.14-1.09], P = 0.01). Levels of fasting blood glucose (SMD = -0.25 [-0.61,0.10], P = 0.15), BMR-RMR (SMD = -0.17 [-0.52-0.18], P = 0.34), systolic blood pressure (SMD = 0.29 [-0.39-0.97], P = 0.40), diastolic blood pressure (SMD = 0.39 [-0.62, 1.40], P = 0.45), CSF melanin-concentrating hormone (MD = 5.56 [-30.79-41.91], P = 0.76), serum growth hormone (SMD = 7.84 [-7.90-23.57], P = 0.33), as well as plasma and CSF leptin (SMD = 0.10 [-1.32-1.51], P = 0.89 and MD = 0.01 [-0.02-0.04], P = 0.56, respectively) did not significantly differ between narcolepsy patients and controls. These findings necessitate early screening of metabolic alterations and cardiovascular risk factors in narcolepsy patients to reduce the morbidity and mortality rates.
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Affiliation(s)
- Soheil Mohammadi
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran; NeuroImaging Network (NIN), Universal Scientific Education and Research Network (USERN), Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Moosaie
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran; NeuroImaging Network (NIN), Universal Scientific Education and Research Network (USERN), Tehran University of Medical Sciences, Tehran, Iran
| | - Amene Saghazadeh
- Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran; MetaCognition Interest Group (MCIG), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Maryam Mahmoudi
- Department of Cellular Molecular Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran; Dietitians and Nutrition Experts Team (DiNET), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Nima Rezaei
- Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran; Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran; Systematic Review and Meta-analysis Expert Group (SRMEG), Universal Scientific Education and Research Network (USERN), Tehran, Iran.
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Quaedackers L, Pillen S, Overeem S. Recognizing the Symptom Spectrum of Narcolepsy to Improve Timely Diagnosis: A Narrative Review. Nat Sci Sleep 2021; 13:1083-1096. [PMID: 34262379 PMCID: PMC8273742 DOI: 10.2147/nss.s278046] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 06/23/2021] [Indexed: 11/23/2022] Open
Abstract
Narcolepsy is a chronic sleep disorder with a strong negative impact on quality of life, especially when untreated. Diagnostic delay is a persistent problem, with obvious detrimental effects on patients. A diagnosis of narcolepsy may be delayed because of its broad symptom presentation which is much more encompassing than the classical "tetrad" of sleepiness, cataplexy, hallucinations, and sleep paralysis. Furthermore, symptoms can vary over time. Presentation of symptoms can also be markedly different between children and adults. Finally, common sleep-related comorbidities increase the risk of narcolepsy being masked by overlapping symptoms or treatment. In this review, we provide a detailed description of the broad and dynamic symptom spectrum of narcolepsy, with specific attention to the different manifestations in both adults and children. The overarching goal is to help not only sleep specialists, but general practitioners, pediatricians, and other caregivers with early recognition and prompt diagnosis of this severe but treatable disorder.
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Affiliation(s)
| | - Sigrid Pillen
- Sleep Medicine Center Kempenhaeghe, Heeze, the Netherlands
| | - Sebastiaan Overeem
- Biomedical Diagnostics Laboratory, Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
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Thieux M, Zhang M, Marcastel A, Herbillon V, Guignard-Perret A, Seugnet L, Lin JS, Guyon A, Plancoulaine S, Franco P. Intellectual Abilities of Children with Narcolepsy. J Clin Med 2020; 9:jcm9124075. [PMID: 33348677 PMCID: PMC7766444 DOI: 10.3390/jcm9124075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 12/11/2020] [Accepted: 12/14/2020] [Indexed: 11/16/2022] Open
Abstract
High cognitive functioning could be a protective factor for school difficulties, behavioral and mood impairments in children with narcolepsy. To investigate this factor, we studied the intellectual abilities of 74 children with narcolepsy (43 boys, 11.7 years old at diagnosis, 91% of cataplexies, 64% obese, 100% HLA positive for DR-DQB1*06:02). All children underwent a one-night polysomnography followed by Multiple Sleep Latency Tests, an evaluation of intelligence quotient (IQ), and filled standardized questionnaires. Thirty-eight percent had high potentialities (HP defined by IQ > 130) and 48% had school difficulties. Using non-parametric tests, we found that HP children reported less difficulties at school and tended to have less impulsivity, conduct, and learning disorders than those without HP. They also tended to be less obese and had less desaturation. Using a multivariate regression analysis, we found an association between the REM sleep percentage and the IQ. REM sleep could be involved in the dynamic changes contributing to the equilibrium of intellectual functioning. This study highlights that despite their frequent school difficulties, narcolepsy per se is unlikely to be a cause of intellectual disability in children. Prompt diagnosis and management of comorbidities such as obesity and obstructive sleep apnea (OSA) could improve cognitive and school performances in these children.
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Affiliation(s)
- Marine Thieux
- Pediatric Sleep Unit, Department of Pediatric Clinical Epileptology, Sleep Disorders and Functional Neurology, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 69500 Lyon, France; (M.T.); (A.M.); (V.H.); (A.G.-P.); (A.G.)
- INSERM, U1028, CNRS, UMR5292, Lyon Neuroscience Research Center, 69500 Lyon, France; (M.Z.); (L.S.); (J.-S.L.)
| | - Min Zhang
- INSERM, U1028, CNRS, UMR5292, Lyon Neuroscience Research Center, 69500 Lyon, France; (M.Z.); (L.S.); (J.-S.L.)
| | - Agathe Marcastel
- Pediatric Sleep Unit, Department of Pediatric Clinical Epileptology, Sleep Disorders and Functional Neurology, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 69500 Lyon, France; (M.T.); (A.M.); (V.H.); (A.G.-P.); (A.G.)
| | - Vania Herbillon
- Pediatric Sleep Unit, Department of Pediatric Clinical Epileptology, Sleep Disorders and Functional Neurology, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 69500 Lyon, France; (M.T.); (A.M.); (V.H.); (A.G.-P.); (A.G.)
| | - Anne Guignard-Perret
- Pediatric Sleep Unit, Department of Pediatric Clinical Epileptology, Sleep Disorders and Functional Neurology, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 69500 Lyon, France; (M.T.); (A.M.); (V.H.); (A.G.-P.); (A.G.)
| | - Laurent Seugnet
- INSERM, U1028, CNRS, UMR5292, Lyon Neuroscience Research Center, 69500 Lyon, France; (M.Z.); (L.S.); (J.-S.L.)
| | - Jian-Sheng Lin
- INSERM, U1028, CNRS, UMR5292, Lyon Neuroscience Research Center, 69500 Lyon, France; (M.Z.); (L.S.); (J.-S.L.)
| | - Aurore Guyon
- Pediatric Sleep Unit, Department of Pediatric Clinical Epileptology, Sleep Disorders and Functional Neurology, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 69500 Lyon, France; (M.T.); (A.M.); (V.H.); (A.G.-P.); (A.G.)
- INSERM, U1028, CNRS, UMR5292, Lyon Neuroscience Research Center, 69500 Lyon, France; (M.Z.); (L.S.); (J.-S.L.)
| | | | - Patricia Franco
- Pediatric Sleep Unit, Department of Pediatric Clinical Epileptology, Sleep Disorders and Functional Neurology, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 69500 Lyon, France; (M.T.); (A.M.); (V.H.); (A.G.-P.); (A.G.)
- INSERM, U1028, CNRS, UMR5292, Lyon Neuroscience Research Center, 69500 Lyon, France; (M.Z.); (L.S.); (J.-S.L.)
- Correspondence: ; Tel./Fax: +33-4-27-85-60-52
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Avidan AY, Kushida CA. The sodium in sodium oxybate: is there cause for concern? Sleep Med 2020; 75:497-501. [PMID: 33022487 DOI: 10.1016/j.sleep.2020.09.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 09/17/2020] [Indexed: 10/23/2022]
Abstract
Sodium oxybate (SO), the sodium salt of γ-hydroxybutyric acid, is one of the primary pharmacologic agents used to treat excessive sleepiness, disturbed nighttime sleep, and cataplexy in narcolepsy. The sodium content of SO ranges from 550 to 1640 mg at 3-9 g, given in two equal nightly doses. Clinicians are advised to consider daily sodium intake in patients with narcolepsy who are treated with SO and have comorbid disorders associated with increased cardiovascular (CV) risk, in whom sodium intake may be a concern. It remains unclear whether all patients with narcolepsy treated with SO should modify or restrict their sodium intake. No data are currently available specific to the sodium content or threshold of SO at which patients might experience increased CV risk. To appraise attributable risk, critical evaluation of the literature was conducted to examine the relationship between CV risk and sodium intake, narcolepsy, and SO exposure. The findings suggest that increased CV risk is associated with extremes of daily sodium intake, and that narcolepsy is associated with comorbidities that may increase CV risk in some patients. However, data from studies regarding SO use in patients with narcolepsy have shown a very low frequency of CV side effects (eg, hypertension) and no overall association with CV risk. In the absence of data that specifically address CV risk with SO based on its sodium content, the clinical evidence to date suggests that SO treatment does not confer additional CV risk in patients with narcolepsy.
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Affiliation(s)
- Alon Y Avidan
- David Geffen School of Medicine at UCLA, 710 Westwood Boulevard, RNRC C153, Los Angeles, 17691, CA, USA.
| | - Clete A Kushida
- Stanford University Medical Center, 450 Broadway Street, MC 5704, Pavilion C, 2nd Floor, Redwood City, CA, USA.
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Franceschini C, Fante C, Filardi M, Folli MC, Brazzi F, Pizza F, D’Anselmo A, Ingravallo F, Antelmi E, Plazzi G. Can a Peer Support the Process of Self-Management in Narcolepsy? A Qualitative Narrative Analysis of a Narcoleptic Patient. Front Psychol 2020; 11:1353. [PMID: 32733314 PMCID: PMC7358570 DOI: 10.3389/fpsyg.2020.01353] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 05/22/2020] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Narcolepsy type 1 (NT1) is a chronic and rare sleep disorder typically arising during adolescence and young adulthood. The main symptoms are excessive daytime sleepiness and cataplexy, a prototypical fall down elicited by huge emotions. Social relationships, school, work, and general health perception are frequently impaired in patients, who often show lower quality-of-life scores. We report which management strategies a young patient (DMG) adopted to cope with NT1 during his growth, avoiding exhibiting serious impairments to his global functioning. METHODS A clinical psychologist explores the history of the patient's disease and the self-acquired strategies used to cope with the symptoms. The patient's global adaptation to the disease, stress-related managing skills, and overall well-being are assessed by standardized scales [Illness Behavior Questionnaire (IBQ); Coping Orientations to Problems Experienced (COPE); and Psychological General Well-Being Index (PGWBI)]. We conducted a qualitative analysis of the patient's narration of his illness according to the procedure of the Grounded Theory. The MAXQDA software program was used to code the verbatim transcript. RESULTS From the qualitative analysis of the interview, three thematic cores emerged: 1) the disease history; 2) the patient's friendship with AD, a friend of his age diagnosed with NT1 since childhood; 3) the strategies used to deal with his symptoms before the diagnosis of NT1 and the related treatment. From the psychometric tests, the patient presents good coping strategies in dealing with stressful problems and events based mainly on acceptance and positive reinterpretation of the stressful situation. CONCLUSION This case shows that comparing peers of the same age and suffering from the same illness improve the patient's self-management ability to cope and live well with NT1.
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Affiliation(s)
| | - Chiara Fante
- Istituto per le Tecnologie Didattiche (ITD), National Research Council (CNR), Genova, Italy
| | - Marco Filardi
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
- IRCCS Institute of Neurological Sciences, Bologna, Italy
| | | | - Francesca Brazzi
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Fabio Pizza
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
- IRCCS Institute of Neurological Sciences, Bologna, Italy
| | - Anita D’Anselmo
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
- IRCCS Institute of Neurological Sciences, Bologna, Italy
| | - Francesca Ingravallo
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Elena Antelmi
- Neurology Unit, Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Giuseppe Plazzi
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
- IRCCS Institute of Neurological Sciences, Bologna, Italy
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Tadrous R, O'Rourke D, Murphy N, Slattery L, Quinn G, Broderick J. Study protocol: A profile of physical performance variables in an outpatient adult population with narcolepsy. HRB Open Res 2020. [DOI: 10.12688/hrbopenres.13086.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Narcolepsy is a sleep disorder characterised by excessive daytime sleepiness and significantly impacts quality of life. People with narcolepsy demonstrate many potential barriers to being physically fit and active, such as sleepiness and social isolation. Very little is known about how physical performance variables may be affected in people with narcolepsy. This study aims to profile the physical fitness of adults with narcolepsy and to explore the relationship between physical fitness and quality of life, symptom severity and disease duration in this cohort. Methods and Analysis: In this cross-sectional observational study, participants will undergo a comprehensive physical performance test battery that will investigate cardiopulmonary fitness, objective measures of physical activity, muscle strength and endurance. Furthermore, quality of life, symptom severity and physical activity will be ascertained through self-report questionnaires. The study population will consist of adults with narcolepsy aged 18-65 years attending the National Narcolepsy Centre located in St. James’s Hospital as an outpatient. Ethics and Dissemination: Ethical approval has been obtained from the St. James’s Hospital and Tallaght University Hospital Research Ethics Committee, and this study is presently underway. The results obtained from this study will be used to help tailor exercise and possible rehabilitation strategies for this population. Dissemination will be sought through peer-reviewed journals, national and international conferences, and through engagement with service user groups. Registration: ClinicalTrials.gov Identifier NCT04419792; registered on 5 June 2020.
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Abstract
PURPOSE OF REVIEW The complex nature of narcolepsy symptoms, along with the use of stimulants and anticataplectic medications, poses diagnostic difficulties in terms of underlying neuropsychiatric comorbidities. This study reviews recent evidence for the association between narcolepsy and neuropsychiatric disorders. We also critically analyze studies that have addressed the neuropsychiatric correlates of patients with narcolepsy, with a discussion of the possible pathophysiological mechanisms linking narcolepsy and neuropsychiatric disorders. RECENT FINDINGS Neuropsychiatric manifestations are common among patients with narcolepsy as narcolepsy and some neuropsychiatric disorders share common clinical features. This may create challenges in making the correct diagnosis, and hence result in a delay in starting appropriate treatment. Comorbid neuropsychiatric manifestations in patients with narcolepsy include depression, anxiety, psychosis, rapid eye movement (REM) sleep behavior disorder, and cognitive impairment. Although hypocretin deficiency has been proposed as a pathophysiological mechanism underlying both narcolepsy and neuropsychiatric disorders, further research is necessary to identify the exact mechanisms. Narcolepsy patients often manifest comorbid neuropsychiatric symptoms, which makes the diagnosis difficult. Therefore, it is essential to address neuropsychiatric symptoms in the clinical care of patients with narcolepsy.
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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: 2.5] [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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Straat ME, Schinkelshoek MS, Fronczek R, Lammers GJ, Rensen PCN, Boon MR. Role of Brown Adipose Tissue in Adiposity Associated With Narcolepsy Type 1. Front Endocrinol (Lausanne) 2020; 11:145. [PMID: 32373062 PMCID: PMC7176868 DOI: 10.3389/fendo.2020.00145] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 03/02/2020] [Indexed: 11/23/2022] Open
Abstract
Narcolepsy type 1 is a neurological sleep-wake disorder caused by the destruction of orexin (hypocretin)-producing neurons. These neurons are particularly located in the lateral hypothalamus and have widespread projections throughout the brain, where they are involved, e.g., in the regulation of the sleep-wake cycle and appetite. Interestingly, a higher prevalence of obesity has been reported in patients with narcolepsy type 1 compared to healthy controls, despite a normal to decreased food intake and comparable physical activity. This suggests the involvement of tissues implicated in total energy expenditure, including skeletal muscle, liver, white adipose tissue (WAT), and brown adipose tissue (BAT). Recent evidence from pre-clinical studies with orexin knock-out mice demonstrates a crucial role for the orexin system in the functionality of brown adipose tissue (BAT), probably through multiple pathways. Since BAT is a highly metabolically active organ that combusts fatty acids and glucose toward heat, thereby contributing to energy metabolism, this raises the question of whether BAT plays a role in the development of obesity and related metabolic diseases in narcolepsy type 1. BAT is densely innervated by the sympathetic nervous system that activates BAT, for instance, following cold exposure. The sympathetic outflow toward BAT is mainly mediated by the dorsomedial, ventromedial, arcuate, and paraventricular nuclei in the hypothalamus. This review focuses on the current knowledge on the role of the orexin system in the control of energy balance, with specific focus on BAT metabolism and adiposity in both preclinical and clinical studies.
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Affiliation(s)
- Maaike E. Straat
- Division of Endocrinology, Department of Medicine, Leiden University Medical Center, Leiden, Netherlands
- Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden, Netherlands
- *Correspondence: Maaike E. Straat
| | - Mink S. Schinkelshoek
- Department of Neurology, Leiden University Medical Center, Leiden, Netherlands
- Sleep Wake Centre SEIN, Heemstede, Netherlands
| | - Rolf Fronczek
- Department of Neurology, Leiden University Medical Center, Leiden, Netherlands
- Sleep Wake Centre SEIN, Heemstede, Netherlands
| | - Gerrit Jan Lammers
- Department of Neurology, Leiden University Medical Center, Leiden, Netherlands
- Sleep Wake Centre SEIN, Heemstede, Netherlands
| | - Patrick C. N. Rensen
- Division of Endocrinology, Department of Medicine, Leiden University Medical Center, Leiden, Netherlands
- Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden, Netherlands
| | - Mariëtte R. Boon
- Division of Endocrinology, Department of Medicine, Leiden University Medical Center, Leiden, Netherlands
- Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden, Netherlands
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Gohil A, Eugster E. Growth Hormone Deficiency and Excessive Sleepiness: A Case Report and Review of the Literature. PEDIATRIC ENDOCRINOLOGY REVIEWS : PER 2019; 17:41-46. [PMID: 31599135 DOI: 10.17458/per.vol17.2019.ge.ghdeficiencyandsleepiness] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The somatotropic axis is intricately involved in normal sleep, as evidenced by the fact that hypothalamic growth hormone-releasing hormone (GHRH) has sleep promoting effects and pituitary growth hormone (GH) release is strongly associated with slow-wave sleep (SWS). Abnormalities in the somatotropic axis, such as GH deficiency of hypothalamic or pituitary origin, result in an alteration of normal sleep patterns which may explain the fatigue reported in these individuals. Sleep disorders such as narcolepsy, in which individuals abnormally enter rapid eye movement (REM) sleep at sleep onset are also associated with an altered GHRH circadian rhythm and abnormal GH secretion. While few studies are available, this review explores what is known about sleep abnormalities in GH deficiency, the effect of treatment on sleep in patients with GH deficiency, and GH secretion in narcolepsy. Emerging evidence suggests a hypothalamic link between narcolepsy and GH secretion. We also describe the unique constellation of isolated idiopathic GH deficiency and severe excessive sleepiness in adopted Nicaraguan siblings, one of which has narcolepsy and the other idiopathic hypersomnia.
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Affiliation(s)
- Anisha Gohil
- Indiana University School of Medicine, Riley Hospital for Children, Fellow, Endocrinology and Diabetes, 705 Riley Hospital Drive, Room 5960, Indianapolis, IN 46202, USA, E-mail:
| | - Erica Eugster
- Indiana University School of Medicine, Riley Hospital for Children, Endocrinology and Diabetes, 705 Riley Hospital Drive, Room 5960, Indianapolis, IN 46202, USA
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Untangling narcolepsy and diabetes: Pathomechanisms with eyes on therapeutic options. Brain Res 2019; 1718:212-222. [DOI: 10.1016/j.brainres.2019.04.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 03/23/2019] [Accepted: 04/13/2019] [Indexed: 12/14/2022]
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Pizza F, Barateau L, Jaussent I, Vandi S, Antelmi E, Mignot E, Dauvilliers Y, Plazzi G. Validation of Multiple Sleep Latency Test for the diagnosis of pediatric narcolepsy type 1. Neurology 2019; 93:e1034-e1044. [PMID: 31405906 DOI: 10.1212/wnl.0000000000008094] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Accepted: 05/21/2019] [Indexed: 01/07/2023] Open
Abstract
ObjectiveTo validate polysomnographic markers (sleep latency and sleep-onset REM periods [SOREMPs] at the Multiple Sleep Latency Test [MSLT] and nocturnal polysomnography [PSG]) for pediatric narcolepsy type 1 (NT1) against CSF hypocretin-1 (hcrt-1) deficiency and presence of cataplexy, as no criteria are currently validated in children.MethodsClinical, neurophysiologic, and, when available, biological data (HLA-DQB1*06:02 positivity, CSF hcrt-1 levels) of 357 consecutive children below 18 years of age evaluated for suspected narcolepsy were collected. Best MSLT cutoffs were obtained by receiver operating characteristic (ROC) curve analysis by contrasting among patients with available CSF hcrt-1 assay (n = 228) with vs without CSF hcrt-1 deficiency, and further validated in patients without available CSF hcrt-1 against cataplexy (n = 129).ResultsPatients with CSF hcrt-1 deficiency were best recognized using a mean MSLT sleep latency ≤8.2 minutes (area under the ROC curve of 0.985), or by at least 2 SOREMPs at the MSLT (area under the ROC curve of 0.975), or the combined PSG + MSLT (area under the ROC curve of 0.977). Although specificity and sensitivity of reference MSLT sleep latency ≤8 minutes and ≥2 SOREMPs (nocturnal SOREMP included) was 100% and 94.87%, the combination of MSLT sleep latency and SOREMP counts did not improve diagnostic accuracy. Age or sex also did not significantly influence these results in our pediatric population.ConclusionsAt least 2 SOREMPs or a mean sleep latency ≤8.2 minutes at the MSLT are valid and reliable markers for pediatric NT1 diagnosis, a result contrasting with adult NT1 criteria.Classification of evidenceThis study provides Class III evidence that for children with suspected narcolepsy, polysomnographic and MSLT markers accurately identify those with narcolepsy type 1.
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Affiliation(s)
- Fabio Pizza
- From the Department of Biomedical and Neuromotor Sciences (DIBINEM) (F.P., S.V., E.A., G.P.), University of Bologna; IRCCS Istituto delle Scienze Neurologiche di Bologna (F.P., S.V., E.A., G.P.), Italy; National Reference Centre for Orphan Diseases, Narcolepsy, Rare Hypersomnias, Sleep Disorders Center, Department of Neurology (L.B., Y.D.), Gui de Chauliac Hospital, Montpellier; Inserm, U1061 (L.B., I.J., Y.D.), Montpellier; University of Montpellier (L.B., I.J., Y.D.), France; and Stanford University Center for Sleep Sciences, Department of Psychiatry and Behavioral Sciences (E.M.), Stanford University School of Medicine, Palo Alto, CA
| | - Lucie Barateau
- From the Department of Biomedical and Neuromotor Sciences (DIBINEM) (F.P., S.V., E.A., G.P.), University of Bologna; IRCCS Istituto delle Scienze Neurologiche di Bologna (F.P., S.V., E.A., G.P.), Italy; National Reference Centre for Orphan Diseases, Narcolepsy, Rare Hypersomnias, Sleep Disorders Center, Department of Neurology (L.B., Y.D.), Gui de Chauliac Hospital, Montpellier; Inserm, U1061 (L.B., I.J., Y.D.), Montpellier; University of Montpellier (L.B., I.J., Y.D.), France; and Stanford University Center for Sleep Sciences, Department of Psychiatry and Behavioral Sciences (E.M.), Stanford University School of Medicine, Palo Alto, CA
| | - Isabelle Jaussent
- From the Department of Biomedical and Neuromotor Sciences (DIBINEM) (F.P., S.V., E.A., G.P.), University of Bologna; IRCCS Istituto delle Scienze Neurologiche di Bologna (F.P., S.V., E.A., G.P.), Italy; National Reference Centre for Orphan Diseases, Narcolepsy, Rare Hypersomnias, Sleep Disorders Center, Department of Neurology (L.B., Y.D.), Gui de Chauliac Hospital, Montpellier; Inserm, U1061 (L.B., I.J., Y.D.), Montpellier; University of Montpellier (L.B., I.J., Y.D.), France; and Stanford University Center for Sleep Sciences, Department of Psychiatry and Behavioral Sciences (E.M.), Stanford University School of Medicine, Palo Alto, CA
| | - Stefano Vandi
- From the Department of Biomedical and Neuromotor Sciences (DIBINEM) (F.P., S.V., E.A., G.P.), University of Bologna; IRCCS Istituto delle Scienze Neurologiche di Bologna (F.P., S.V., E.A., G.P.), Italy; National Reference Centre for Orphan Diseases, Narcolepsy, Rare Hypersomnias, Sleep Disorders Center, Department of Neurology (L.B., Y.D.), Gui de Chauliac Hospital, Montpellier; Inserm, U1061 (L.B., I.J., Y.D.), Montpellier; University of Montpellier (L.B., I.J., Y.D.), France; and Stanford University Center for Sleep Sciences, Department of Psychiatry and Behavioral Sciences (E.M.), Stanford University School of Medicine, Palo Alto, CA
| | - Elena Antelmi
- From the Department of Biomedical and Neuromotor Sciences (DIBINEM) (F.P., S.V., E.A., G.P.), University of Bologna; IRCCS Istituto delle Scienze Neurologiche di Bologna (F.P., S.V., E.A., G.P.), Italy; National Reference Centre for Orphan Diseases, Narcolepsy, Rare Hypersomnias, Sleep Disorders Center, Department of Neurology (L.B., Y.D.), Gui de Chauliac Hospital, Montpellier; Inserm, U1061 (L.B., I.J., Y.D.), Montpellier; University of Montpellier (L.B., I.J., Y.D.), France; and Stanford University Center for Sleep Sciences, Department of Psychiatry and Behavioral Sciences (E.M.), Stanford University School of Medicine, Palo Alto, CA
| | - Emmanuel Mignot
- From the Department of Biomedical and Neuromotor Sciences (DIBINEM) (F.P., S.V., E.A., G.P.), University of Bologna; IRCCS Istituto delle Scienze Neurologiche di Bologna (F.P., S.V., E.A., G.P.), Italy; National Reference Centre for Orphan Diseases, Narcolepsy, Rare Hypersomnias, Sleep Disorders Center, Department of Neurology (L.B., Y.D.), Gui de Chauliac Hospital, Montpellier; Inserm, U1061 (L.B., I.J., Y.D.), Montpellier; University of Montpellier (L.B., I.J., Y.D.), France; and Stanford University Center for Sleep Sciences, Department of Psychiatry and Behavioral Sciences (E.M.), Stanford University School of Medicine, Palo Alto, CA
| | - Yves Dauvilliers
- From the Department of Biomedical and Neuromotor Sciences (DIBINEM) (F.P., S.V., E.A., G.P.), University of Bologna; IRCCS Istituto delle Scienze Neurologiche di Bologna (F.P., S.V., E.A., G.P.), Italy; National Reference Centre for Orphan Diseases, Narcolepsy, Rare Hypersomnias, Sleep Disorders Center, Department of Neurology (L.B., Y.D.), Gui de Chauliac Hospital, Montpellier; Inserm, U1061 (L.B., I.J., Y.D.), Montpellier; University of Montpellier (L.B., I.J., Y.D.), France; and Stanford University Center for Sleep Sciences, Department of Psychiatry and Behavioral Sciences (E.M.), Stanford University School of Medicine, Palo Alto, CA.
| | - Giuseppe Plazzi
- From the Department of Biomedical and Neuromotor Sciences (DIBINEM) (F.P., S.V., E.A., G.P.), University of Bologna; IRCCS Istituto delle Scienze Neurologiche di Bologna (F.P., S.V., E.A., G.P.), Italy; National Reference Centre for Orphan Diseases, Narcolepsy, Rare Hypersomnias, Sleep Disorders Center, Department of Neurology (L.B., Y.D.), Gui de Chauliac Hospital, Montpellier; Inserm, U1061 (L.B., I.J., Y.D.), Montpellier; University of Montpellier (L.B., I.J., Y.D.), France; and Stanford University Center for Sleep Sciences, Department of Psychiatry and Behavioral Sciences (E.M.), Stanford University School of Medicine, Palo Alto, CA.
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Schinkelshoek MS, Smolders IM, Donjacour CE, van der Meijden WP, van Zwet EW, Fronczek R, Lammers GJ. Decreased body mass index during treatment with sodium oxybate in narcolepsy type 1. J Sleep Res 2019; 28:e12684. [PMID: 29504180 PMCID: PMC7378953 DOI: 10.1111/jsr.12684] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 01/31/2018] [Accepted: 02/01/2018] [Indexed: 12/29/2022]
Abstract
Narcolepsy type 1 is characterised by an increase in body weight after disease onset, frequently leading to obesity. It was suggested that this weight gain may be counteracted by treatment with sodium oxybate. We here provide longitudinal body mass index data of patients with narcolepsy type 1 after starting treatment with sodium oxybate, compared with patients in whom treatment with modafinil was initiated. Eighty-one individuals with narcolepsy type 1 fulfilled the entry criteria for this retrospective study: 59 had newly started treatment with sodium oxybate and 22 had newly started modafinil. Gender-specific differences between both treatment groups were compared using Student's t tests and mixed effect modeling. Patients using sodium oxybate lost weight, with a mean body mass index decrease of 2.56 kg/m2 between the first and last measurement (women; p = .001) and 0.84 kg/m2 (men; p = .006). Patients using modafinil, however, gained weight, with a mean body mass index increase of 0.57 kg/m2 (women; p = .033) and 0.67 kg/m2 (men; p = .122). Medication (p = .006) and baseline body mass index (p = .032) were predictors for body mass index decrease. In conclusion, treatment with sodium oxybate is associated with a body mass index reduction in narcolepsy type 1, whereas modafinil treatment is not. This effect is most pronounced in those who already have a higher baseline body mass index.
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Affiliation(s)
- Mink S. Schinkelshoek
- Department of NeurologyLeiden University Medical CenterLeidenThe Netherlands
- Sleep‐Wake CenterStichting Epilepsie Instellingen Nederland (SEIN)HeemstedeThe Netherlands
| | | | - Claire E. Donjacour
- Department of NeurologyLeiden University Medical CenterLeidenThe Netherlands
- Sleep‐Wake CenterStichting Epilepsie Instellingen Nederland (SEIN)ZwolleThe Netherlands
| | - Wisse P. van der Meijden
- Department of Sleep and CognitionNetherlands Institute for NeuroscienceRoyal Netherlands Academy of Arts and SciencesAmsterdamThe Netherlands
| | - Erik W. van Zwet
- Department of Medical Statistics and BioinformaticsLeiden University Medical CenterLeidenThe Netherlands
| | - Rolf Fronczek
- Department of NeurologyLeiden University Medical CenterLeidenThe Netherlands
- Sleep‐Wake CenterStichting Epilepsie Instellingen Nederland (SEIN)HeemstedeThe Netherlands
| | - Gert Jan Lammers
- Department of NeurologyLeiden University Medical CenterLeidenThe Netherlands
- Sleep‐Wake CenterStichting Epilepsie Instellingen Nederland (SEIN)HeemstedeThe Netherlands
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36
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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: 22] [Impact Index Per Article: 4.4] [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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Abstract
Narcolepsy is the most common neurological cause of chronic sleepiness. The discovery about 20 years ago that narcolepsy is caused by selective loss of the neurons producing orexins (also known as hypocretins) sparked great advances in the field. Here, we review the current understanding of how orexin neurons regulate sleep-wake behaviour and the consequences of the loss of orexin neurons. We also summarize the developing evidence that narcolepsy is an autoimmune disorder that may be caused by a T cell-mediated attack on the orexin neurons and explain how these new perspectives can inform better therapeutic approaches.
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Affiliation(s)
- Carrie E Mahoney
- Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Andrew Cogswell
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Igor J Koralnik
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Thomas E Scammell
- Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.
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Almeneessier AS, Alballa NS, Alsalman BH, Aleissi S, Olaish AH, BaHammam AS. A 10-Year Longitudinal Observational Study Of Cataplexy In A Cohort Of Narcolepsy Type 1 Patients. Nat Sci Sleep 2019; 11:231-239. [PMID: 31695532 PMCID: PMC6814360 DOI: 10.2147/nss.s229105] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 09/29/2019] [Indexed: 12/29/2022] Open
Abstract
PURPOSE Narcolepsy type 1 (NT1) is thought to have a chronic persistent course. This study aimed to assess the natural course of cataplexy in patients with NT1 at 2, 6, and 10 years after stabilizing symptoms. Other secondary objectives included assessing sleep quality, body mass index (BMI), and comorbidities at recruitment and 10 years later. PATIENTS AND METHODS Cataplexy symptoms, the Epworth sleepiness scale (ESS), sleep quality (assessed using the Pittsburgh sleep quality index [PSQI]), BMI, and comorbid conditions were prospectively monitored in 38 patients with NT1. The study sample comprised 38 patients with narcolepsy (males=27). The mean ages at disease onset and recruitment were 17.7 ± 5.6 years and 24.3 ± 8.6 years, respectively. RESULTS In 42% of the cohort, the anti-cataplectic medications were stopped at the end of the study without disturbing symptoms of cataplexy. Additionally, there was an apparent significant reduction in the frequency of cataplexy over time. The mean ESS score decreased by more than 4 points from 19.4 ± 2.9 to 15 ± 4.3 (p<0.001) while on the same pharmacotherapy. The number of patients with a PSQI score of <5 (indicating good sleep quality) increased from 6 (15.8%) to 15 (39.5%) (p=0.004). The BMI increased from 30 ± 5.1 to 33.3 ± 6 kg/m2 (p=0.001). No changes were documented in comorbidities. CONCLUSION The findings suggest that the course of NT1 is not stable. Over a 10-year period, cataplexy symptoms improved or disappeared in a large proportion of patients, and there was an improvement in daytime sleepiness and nighttime sleep quality. More prospective studies that repeatedly monitor CSF-HCRT are needed to confirm the current findings.
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Affiliation(s)
- Aljohara S Almeneessier
- Department of Medicine, College of Medicine, the University Sleep Disorders Center, Riyadh, Saudi Arabia.,Family and Community Medicine Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Nouf S Alballa
- Department of Medicine, College of Medicine, the University Sleep Disorders Center, Riyadh, Saudi Arabia
| | - Budoor H Alsalman
- Department of Medicine, College of Medicine, the University Sleep Disorders Center, Riyadh, Saudi Arabia
| | - Salih Aleissi
- Department of Medicine, College of Medicine, the University Sleep Disorders Center, Riyadh, Saudi Arabia
| | - Awad H Olaish
- Department of Medicine, College of Medicine, the University Sleep Disorders Center, Riyadh, Saudi Arabia
| | - Ahmed S BaHammam
- Department of Medicine, College of Medicine, the University Sleep Disorders Center, Riyadh, Saudi Arabia
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39
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Vignatelli L, Antelmi E, Ceretelli I, Bellini M, Carta C, Cortelli P, Ferini-Strambi L, Ferri R, Guerrini R, Ingravallo F, Marchiani V, Mari F, Pieroni G, Pizza F, Verga MC, Verrillo E, Taruscio D, Plazzi G. Red Flags for early referral of people with symptoms suggestive of narcolepsy: a report from a national multidisciplinary panel. Neurol Sci 2018; 40:447-456. [PMID: 30539345 PMCID: PMC6433801 DOI: 10.1007/s10072-018-3666-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Accepted: 11/28/2018] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Narcolepsy is a lifelong disease, manifesting with excessive daytime sleepiness and cataplexy, arising between childhood and young adulthood. The diagnosis is typically made after a long delay that burdens the disease severity. The aim of the project, promoted by the "Associazione Italiana Narcolettici e Ipersonni" is to develop Red Flags to detect symptoms for early referral, targeting non-sleep medicine specialists, general practitioners, and pediatricians. MATERIALS AND METHODS A multidisciplinary panel, including patients, public institutions, and representatives of national scientific societies of specialties possibly involved in the diagnostic process of suspected narcolepsy, was convened. The project was accomplished in three phases. Phase 1: Sleep experts shaped clinical pictures of narcolepsy in pediatric and adult patients. On the basis of these pictures, Red Flags were drafted. Phase 2: Representatives of the scientific societies and patients filled in a form to identify barriers to the diagnosis of narcolepsy. Phase 3: The panel produced suggestions for the implementation of Red Flags. RESULTS Red Flags were produced representing three clinical pictures of narcolepsy in pediatric patients ((1) usual sleep symptoms, (2) unusual sleep symptoms, (3) endocrinological signs) and two in adult patients ((1) usual sleep symptoms, (2) unusual sleep symptoms). Inadequate knowledge of symptoms at onset by medical doctors turned out to be the main reported barrier to diagnosis. CONCLUSIONS This report will hopefully enhance knowledge and awareness of narcolepsy among non-specialists in sleep medicine in order to reduce the diagnostic delay that burdens patients in Italy. Similar initiatives could be promoted across Europe.
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Affiliation(s)
- L Vignatelli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - E Antelmi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, via Ugo Foscolo n 7, 40123, Bologna, Italy
| | - I Ceretelli
- Associazione Italiana Narcolettici e Ipersonni (AIN), Florence, Italy
| | - M Bellini
- Azienda USL Toscana centro Sedi di Prato, Prato, Italy
| | - C Carta
- National Centre for Rare Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - P Cortelli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, via Ugo Foscolo n 7, 40123, Bologna, Italy
| | - L Ferini-Strambi
- Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - R Ferri
- Sleep Research Centre, Department of Neurology I.C., Oasi Research Institute - IRCCS, Troina, Italy
| | - R Guerrini
- Pediatric Neurology, Neurogenetics and Neurobiology Unit and Laboratories, Children's Hospital A. Meyer-University of Florence, Florence, Italy
| | - F Ingravallo
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - V Marchiani
- Child Neuropsychiatric Unit, Polyclinic S. Orsola-Malpighi, University of Bologna, Bologna, Italy
| | - F Mari
- Pediatric Neurology, Neurogenetics and Neurobiology Unit and Laboratories, Children's Hospital A. Meyer-University of Florence, Florence, Italy
| | - G Pieroni
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - F Pizza
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, via Ugo Foscolo n 7, 40123, Bologna, Italy
| | - M C Verga
- Primary Care Pediatrics, ASL Salerno, Vietri sul Mare, SA, Italy
| | - E Verrillo
- Sleep and Long Term Ventilation Unit, Pediatric Pulmonology & Respiratory Intermediate Care Unit, Academic Department of Pediatrics (DPUO) Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - D Taruscio
- National Centre for Rare Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Giuseppe Plazzi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.
- Department of Biomedical and Neuromotor Sciences, University of Bologna, via Ugo Foscolo n 7, 40123, Bologna, Italy.
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Franco P, Dauvilliers Y, Inocente CO, Guyon A, Villanueva C, Raverot V, Plancoulaine S, Lin JS. Impaired histaminergic neurotransmission in children with narcolepsy type 1. CNS Neurosci Ther 2018; 25:386-395. [PMID: 30225986 DOI: 10.1111/cns.13057] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Revised: 08/03/2018] [Accepted: 08/04/2018] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE Narcolepsy is a sleep disorder characterized in humans by excessive daytime sleepiness and cataplexy. Greater than fifty percent of narcoleptic patients have an onset of symptoms prior to the age of 18. Current general agreement considers the loss of hypothalamic hypocretin (orexin) neurons as the direct cause of narcolepsy notably cataplexy. To assess whether brain histamine (HA) is also involved, we quantified the cerebrospinal fluid (CSF) levels of HA and tele-methylhistamine (t-MeHA), the direct metabolite of HA between children with orexin-deficient narcolepsy type 1 (NT1) and controls. METHODS We included 24 children with NT1 (12.3 ± 3.6 years, 11 boys, 83% cataplexy, 100% HLA DQB1*06:02) and 21 control children (11.2 ± 4.2 years, 10 boys). CSF HA and t-MeHA were measured in all subjects using a highly sensitive liquid chromatographic-electrospray/tandem mass spectrometric assay. CSF hypocretin-1 values were determined in the narcoleptic patients. RESULTS Compared with the controls, NT1 children had higher CSF HA levels (771 vs 234 pmol/L, P < 0.001), lower t-MeHA levels (879 vs 1924 pmol/L, P < 0.001), and lower t-MeHA/HA ratios (1.1 vs 8.2, P < 0.001). NT1 patients had higher BMI z-scores (2.7 ± 1.6 vs 1.0 ± 2.3, P = 0.006) and were more often obese (58% vs 29%, P = 0.05) than the controls. Multivariable analyses including age, gender, and BMI z-score showed a significant decrease in CSF HA levels when the BMI z-score increased in patients (P = 0.007) but not in the controls. No association was found between CSF HA, t-MeHA, disease duration, age at disease onset, the presence of cataplexy, lumbar puncture timing, and CSF hypocretin levels. CONCLUSIONS Narcolepsy type 1 children had a higher CSF HA level together with a lower t-MeHA level leading to a significant decrease in the t-MeHA/HA ratios. These results suggest a decreased HA turnover and an impairment of histaminergic neurotransmission in narcoleptic children and support the use of a histaminergic therapy in the treatment against narcolepsy.
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Affiliation(s)
- Patricia Franco
- Integrative Physiology of the Brain Arousal System, CRNL, INSERM-U1028, CNRS, UMR5292, University Lyon1, Lyon, France.,National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic hypersomnia and Kleine-Levin Syndrome (CNR narcolepsie-hypersomnie), Bron, France.,Pediatric Sleep Unit, Mother- Children Hospital, Hospices Civils de Lyon, University Lyon1, Lyon, France
| | - Yves Dauvilliers
- National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic hypersomnia and Kleine-Levin Syndrome (CNR narcolepsie-hypersomnie), Bron, France.,Sleep Unit, Department of Neurology, Gui de Chauliac Hospital, CHU Montpellier, Montpellier, France.,Inserm, U1061, Univ Montpellier 1, Montpellier, France
| | - Clara Odilia Inocente
- Integrative Physiology of the Brain Arousal System, CRNL, INSERM-U1028, CNRS, UMR5292, University Lyon1, Lyon, France
| | - Aurore Guyon
- Integrative Physiology of the Brain Arousal System, CRNL, INSERM-U1028, CNRS, UMR5292, University Lyon1, Lyon, France.,National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic hypersomnia and Kleine-Levin Syndrome (CNR narcolepsie-hypersomnie), Bron, France.,Pediatric Sleep Unit, Mother- Children Hospital, Hospices Civils de Lyon, University Lyon1, Lyon, France
| | - Carine Villanueva
- Department of Endocrinology, Mother- Children Hospital, Hospices Civils de Lyon, University Lyon1, France
| | - Veronique Raverot
- Laboratoire de Hormonologie, Groupement Est, Hospices Civils de Lyon, University Lyon1, Lyon, France
| | - Sabine Plancoulaine
- INSERM, UMR1153, Centre of Research in Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Villejuif, Paris-Descartes University, Paris, France
| | - Jian-Sheng Lin
- Integrative Physiology of the Brain Arousal System, CRNL, INSERM-U1028, CNRS, UMR5292, University Lyon1, Lyon, France
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Romigi A, Vitrani G, Lo Giudice T, Centonze D, Franco V. Profile of pitolisant in the management of narcolepsy: design, development, and place in therapy. DRUG DESIGN DEVELOPMENT AND THERAPY 2018; 12:2665-2675. [PMID: 30214155 PMCID: PMC6124464 DOI: 10.2147/dddt.s101145] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Narcolepsy is a rare sleep disorder characterized by excessive daytime sleepiness and rapid eye movement sleep dysregulation, manifesting as cataplexy and sleep paralysis, as well as hypnagogic and hypnopompic hallucinations. Disease onset may occur at any age, although adolescents and young adults are mainly affected. Currently, the diagnosis delay ranges from 8 to 10 years and drug therapy may only attenuate symptoms. Pitolisant is a first-in-class new drug currently authorized by the European Medicines Agency to treat narcolepsy with or without cataplexy in adults and with an expanded evaluation for the treatment of neurologic diseases such as Parkinson’s disease and epilepsy. This article reviews the pharmacokinetic and pharmacodynamic profile of pitolisant, highlighting its effectiveness and safety in patients with narcolepsy. We performed a systematic review of the literature using PubMed, Embase, and Google Scholar. We report on the efficacy and safety data of pitolisant in narcoleptic patients regarding cataplexy episodes and subjective and objective daytime sleepiness. The development program of pitolisant was characterized by eight Phase II/III studies. One proof-of-concept study followed by two pivotal studies, three randomized controlled trials, and two open studies were evaluated. Our review confirmed the effectiveness of pitolisant in treating major clinically relevant narcolepsy symptoms, including cataplexy, as compared to placebo. In addition, pitolisant revealed a safe profile when compared with placebo and active comparators. Headache, insomnia, and nausea were the prominent side effects. Further long-term randomized controlled trials comparing the efficacy of pitolisant with active comparators (ie, modafinil and sodium oxybate) may clarify its real place in therapy and its possible use as a first-line agent on the basis of its safety and tolerability.
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Affiliation(s)
- Andrea Romigi
- IRCCS Istituto Neurologico Mediterraneo Neuromed, Pozzilli (IS), Italy,
| | - Giuseppe Vitrani
- IRCCS Istituto Neurologico Mediterraneo Neuromed, Pozzilli (IS), Italy,
| | | | - Diego Centonze
- IRCCS Istituto Neurologico Mediterraneo Neuromed, Pozzilli (IS), Italy, .,Department of System Medicine, University of Rome Tor Vergata Rome, Italy
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Filardi M, Pizza F, Antelmi E, Pillastrini P, Natale V, Plazzi G. Physical Activity and Sleep/Wake Behavior, Anthropometric, and Metabolic Profile in Pediatric Narcolepsy Type 1. Front Neurol 2018; 9:707. [PMID: 30197622 PMCID: PMC6117389 DOI: 10.3389/fneur.2018.00707] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 08/03/2018] [Indexed: 12/26/2022] Open
Abstract
Objectives: Regular physical activity is routinely recommended in children and adolescents suffering from narcolepsy type 1 (NT1), but controlled studies analyzing its influence on sleep/wake behavior, metabolic, and anthropometric profile in pediatric NT1 are lacking. Methods: Fifty consecutive drug-naïve NT1 children and adolescents were assessed through actigraphic, clinical, and metabolic evaluations. Patients were compared with respect to their engagement in leisure-time physical activities (LTPA): patients engaged in LTPA (n = 30) and patients not engaged (No-LTPA, n = 20), respectively. Results: LTPA patients presented lower BMI, with different BMI categories distribution and higher HDL cholesterol, when compared with No-LTPA subjects. Increased night-sleep duration, higher sleep quality, and reduction of nap frequency were documented through actigraphy in LTPA subjects. Subjective sleepiness, as measured by ESS-CHAD, was also lower in LTPA subjects while cataplexy frequency proved similar between the two groups. Discussion: In pediatric NT1 patients, regular engagement in LTPA is associated with significant differences on sleepiness, anthropometric and metabolic profile and objectively assessed sleep/wake behavior. Engagement in LTPA is beneficial and should be strongly encouraged in pediatric NT1 patients.
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Affiliation(s)
- Marco Filardi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Fabio Pizza
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna (ISNB), Azienda Unità Sanitaria Locale (AUSL) di Bologna, Bologna, Italy
| | - Elena Antelmi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna (ISNB), Azienda Unità Sanitaria Locale (AUSL) di Bologna, Bologna, Italy
| | - Paolo Pillastrini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Vincenzo Natale
- Department of Psychology, University of Bologna, Bologna, Italy
| | - Giuseppe Plazzi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna (ISNB), Azienda Unità Sanitaria Locale (AUSL) di Bologna, Bologna, Italy
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Plazzi G, Clawges HM, Owens JA. Clinical Characteristics and Burden of Illness in Pediatric Patients with Narcolepsy. Pediatr Neurol 2018; 85:21-32. [PMID: 30190179 DOI: 10.1016/j.pediatrneurol.2018.06.008] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 06/19/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND Narcolepsy is a chronic and lifelong neurologic disorder with onset commonly occurring in childhood or adolescence, and affecting approximately 0.025% to 0.05% of the general population. The primary symptom is excessive daytime sleepiness, which is accompanied by cataplexy in 70% of patients. Other common symptoms include sleep paralysis, hallucinations upon falling asleep or waking, and disrupted nocturnal sleep. Narcolepsy is associated with a considerable burden of illness (BOI), which has been well characterized in adults, and is exacerbated by delays in symptom recognition, diagnosis, and intervention. METHODS This review describes the specific characteristics and BOI of pediatric narcolepsy, using a wide range of published research data. RESULTS Pediatric narcolepsy presents distinct challenges in diagnosis and management. Narcolepsy symptoms often initially manifest differently in children and adolescents versus adults, which may pose diagnostic dilemmas. Children often respond to sleepiness with irritability, hyperactivity, and poor attention, which may be misinterpreted as misbehavior or neurocognitive sequelae of other conditions. Pediatric cataplexy symptoms may include subtle and unusual facial expressions or choreic-like movements, which are not observed in adults. Insufficient sleep and circadian rhythm disorders presenting with excessive daytime sleepiness are common in adolescents, potentially confounding narcolepsy diagnosis. Pediatric narcolepsy is also associated with comorbidities including rapid weight gain, precocious puberty, and attention deficit hyperactivity disorder, and increased risk for deficits in social functioning, depression, and anxiety. School performance is also typically impaired, requiring special education services. CONCLUSIONS Thus, the discrete BOI of pediatric narcolepsy underscores the need for prompt and accurate diagnosis, and appropriate treatment of this disorder.
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Affiliation(s)
- Giuseppe Plazzi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy; IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.
| | - Heather M Clawges
- Department of Pediatrics, Sleep Medicine, Robert C. Byrd Health Sciences Center, West Virginia University, Morgantown, WestVirginia
| | - Judith A Owens
- Division of Neurology, Boston Children's Hospital, Harvard Medical School, Waltham, Massachusetts
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Plazzi G, Ruoff C, Lecendreux M, Dauvilliers Y, Rosen CL, Black J, Parvataneni R, Guinta D, Wang YG, Mignot E. Treatment of paediatric narcolepsy with sodium oxybate: a double-blind, placebo-controlled, randomised-withdrawal multicentre study and open-label investigation. THE LANCET CHILD & ADOLESCENT HEALTH 2018; 2:483-494. [DOI: 10.1016/s2352-4642(18)30133-0] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 04/06/2018] [Accepted: 04/10/2018] [Indexed: 10/16/2022]
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45
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Sleep disorders during childhood: a practical review. Eur J Pediatr 2018; 177:641-648. [PMID: 29502303 DOI: 10.1007/s00431-018-3116-z] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 02/06/2018] [Accepted: 02/09/2018] [Indexed: 12/27/2022]
Abstract
Sleep disorders are a common problem during childhood. The consequences are variable, and sleep disorders can influence medical, psychological and developmental aspects of the growing child. It is important to recognize sleep disorders and to treat them correctly. We discuss common sleep disorders during childhood using the 3rd edition of the International Classification of Sleep Disorders. We analyze the different sleep disorders from a clinical approach and provide an overview of adequate treatment options.Conlusion: This review discusses common sleep disorders during childhood using the 3rd edition of the International Classification of Sleep Disorders. We analyze the different sleep disorders from a clinical approach and provide an overview of adequate treatment options. What is known: • Sleep disorders are a common problem during childhood. • The consequences are variable, and sleep disorders can influence medical, psychological, and developmental aspects of the growing child. What is new: • Pediatricians should routinely screen for sleep and sleep disorders. • It is important to recognize sleep disorders and to treat them correctly.
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46
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The clinical spectrum of childhood narcolepsy. Sleep Med Rev 2018; 38:70-85. [DOI: 10.1016/j.smrv.2017.04.003] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 04/13/2017] [Accepted: 04/19/2017] [Indexed: 12/19/2022]
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47
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Pérez-Carbonell L, Leschziner G. Clinical update on central hypersomnias. J Thorac Dis 2018; 10:S112-S123. [PMID: 29445535 PMCID: PMC5803059 DOI: 10.21037/jtd.2017.10.161] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 09/05/2017] [Indexed: 12/28/2022]
Abstract
The central hypersomnias encompass a range of conditions causing persisting or intermittent excessive daytime sleepiness (EDS). These conditions therefore present not infrequently in general clinical sleep practice, and remain in the differential for patients presenting with sleepiness. Our understanding of the pathophysiology, diagnosis and management of these conditions has progressed significantly over recent years, and in this article we review this group of disorders, focussing in particular on recent changes in classification and diagnosis, pathophysiological advances, and novel treatment options.
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Affiliation(s)
- Laura Pérez-Carbonell
- Sleep Disorders Centre, Guy’s and St Thomas’ NHS Foundation Trust, Guy’s Hospital, London, UK
| | - Guy Leschziner
- Sleep Disorders Centre, Guy’s and St Thomas’ NHS Foundation Trust, Guy’s Hospital, London, UK
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
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48
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Rossor T, Lim M, VanDenEshof K, Gringras P. Pseudotumor cerebri syndrome in a patient with narcolepsy type 1. Eur J Paediatr Neurol 2018; 22:194-198. [PMID: 29195824 DOI: 10.1016/j.ejpn.2017.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 10/09/2017] [Accepted: 11/14/2017] [Indexed: 10/18/2022]
Abstract
Type 1 narcolepsy (NT1) is a chronic primary disorder of hypersomnolence characterized by excessive daytime sleepiness, cataplexy, sleep paralysis, hypnagogic hallucinations and disrupted nocturnal sleep. NT1 is linked to hypothalamic hypocretin deficiency, strongly associated with Human Leukocyte Antigen (HLA) marker DQB1*06:02 and of probable autoimmune origin. NT1 is usually associated with increased rates of overweight and obesity, and sometimes with increases in overnight blood pressure and increased rates of hypoventilation with raised CO2 levels overnight. Many of these are predisposing factors for pseudotumor cerebri syndrome (PTCS). We present a case of a young girl with both NT1 and PTCS that responded well to treatment with acetazolamide after early identification, with improvement of headache and resolution of hypoventilation.
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Affiliation(s)
- Thomas Rossor
- Children's Neurosciences, Evelina London Children's Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, King's Health Partners Academic Health Science Centre, UK
| | - Ming Lim
- Children's Neurosciences, Evelina London Children's Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, King's Health Partners Academic Health Science Centre, UK
| | - Kirandeep VanDenEshof
- Children's Sleep Medicine Department, Evelina London Children's Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, King's Health Partners Academic Health Science Centre, UK
| | - Paul Gringras
- Children's Sleep Medicine Department, Evelina London Children's Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, King's Health Partners Academic Health Science Centre, UK.
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49
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The link between narcolepsy and autonomic cardiovascular dysfunction: a translational perspective. Clin Auton Res 2017; 28:545-555. [DOI: 10.1007/s10286-017-0473-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 09/25/2017] [Indexed: 01/09/2023]
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50
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Pillen S, Pizza F, Dhondt K, Scammell TE, Overeem S. Cataplexy and Its Mimics: Clinical Recognition and Management. Curr Treat Options Neurol 2017; 19:23. [PMID: 28478511 DOI: 10.1007/s11940-017-0459-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OPINION STATEMENT This review describes the diagnosis and management of cataplexy: attacks of bilateral loss of muscle tone, triggered by emotions and with preserved consciousness. Although cataplexy is rare, its recognition is important as in most cases, it leads to a diagnosis of narcolepsy, a disorder that still takes a median of 9 years to be diagnosed. The expression of cataplexy varies widely, from partial episodes affecting only the neck muscles to generalized attacks leading to falls. Moreover, childhood cataplexy differs from the presentation in adults, with a prominent facial involvement, already evident without clear emotional triggers ('cataplectic facies') and 'active' motor phenomena especially of the tongue and perioral muscles. Next to narcolepsy, cataplexy can sometimes be caused by other diseases, such as Niemann-Pick type C, Prader Willi Syndrome, or lesions in the hypothalamic or pontomedullary region. Cataplexy mimics include syncope, epilepsy, hyperekplexia, drop attacks and pseudocataplexy. They can be differentiated from cataplexy using thorough history taking, supplemented with (home)video recordings whenever possible. Childhood narcolepsy, with its profound facial hypotonia, can be confused with neuromuscular disorders, and the active motor phenomenona resemble those found in childhood movement disorders such as Sydenham's chorea. Currently, the diagnosis of cataplexy is made almost solely on clinical grounds, based on history taking and (home) videos. Cataplexy shows remarkable differences in childhood compared to adults, with profound facial hypotonia and complex active motor phenomena. Over time, these severe symptoms evolve to the milder adult phenotype, and this pattern is crucial to recognize when assessing the outcome of uncontrolled case series with potential treatments such as immunomodulation. Symptomatic treatment is possible with antidepressants and sodium oxybate. Importantly, management also needs to involve sleep hygiene advice, safety measures whenever applicable and guidance with regard to the social sequelae of cataplexy.
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Affiliation(s)
- Sigrid Pillen
- Sleep Medicine Center Kempenhaeghe, P.O. Box 61, , 5590 AB, Heeze, The Netherlands.
| | - Fabio Pizza
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy.,IRCCS Institute of the Neurological SciencesAUSL di Bologna, Bologna, Italy
| | - Karlien Dhondt
- Department Pediatrics, Division of Child Neurology & Metabolism, Pediatric Sleep Center, Ghent University Hospital, Ghent, Belgium
| | - Thomas E Scammell
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston Children's Hospital, Boston, MA, USA
| | - Sebastiaan Overeem
- Sleep Medicine Center Kempenhaeghe, P.O. Box 61, , 5590 AB, Heeze, The Netherlands.,Eindhoven University of Technology, Eindhoven, The Netherlands
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