In patients with OSAS, co-treatment with continuous positive airway pressure (CPAP) is often indicated. Sodium oxybate should not be used in conjunction with other sedatives or alcohol. While the most frequent side effect is nausea, the most disabling ones are enuresis and sleep walking. Nevertheless, sodium oxybate has a black box warning because it is a potent CNS depressant with abuse potential. Side-effects are usually mild, particularly when compared to those occurring with other drugs. Efficacy and side-effects are both dose-dependent. Sodium oxybate, acting as an agonist at the GABAB receptor is effective in reducing EDS, particularly at dosages of 6-9 grams per night (divided in 2 doses, the second dose must be ingested 3-4 hours after the first). Modafinil for example increases the metabolism of oral contraceptives. The possibility of induction of human hepatic cytochrome P450 enzymes by modafinil should be borne in mind. The quick and short acting stimulants can be used to good effect when ‘targeted’ at social events or difficult periods during the day. Dexamphetamine and sustained release formulations are off-label in most European countries. Long-acting agents (modafinil, armodafinil, dexamphetamine, and sustained release formulations of methylphenidate) seem to be better tolerated than short acting drugs (methylphenidate). Addiction does not seem to be a problem in narcoleptics though data are limited. Side-effects and tolerance are major drawbacks in the use of stimulants. These drugs enhance the release and inhibit the re-uptake of catecholamine and to a lesser extent of serotonin in the central nervous system and the periphery.

These include dexamphetamine (5-60 mg /day), methylphenidate (10-60 mg / day), modafinil (100-400 mg / day), and armodafinil (150-250 mg / day). Stimulants are the main treatment for EDS. T reatment of excessive daytime sleepiness (EDS) Alcohol and sedating daytime medication should preferably be avoided. Scheduled daytime naps or short naps just before certain activities demanding a high degree of attention temporarily improve sleepiness in most patients. Patients should provide themselves the opportunity to have enough nocturnal sleep, and live a regular life: going to bed at the same hour each night, and getting up at the same time each morning as much as possible. – There are only two treatment modalities with proven efficacy: lifestyle advice and pharmacological therapy. – Acceptance of the diagnosis is crucial and facilitates adherence to therapeutic advices. – Information about the disease should be provided to the patients and relatives. All rights reserved.General aspects of management and treatment

Copyright © 2020 Wolters Kluwer Health, Inc. This case report suggests that aripiprazole may be safely used in some adolescents who diagnosed with IC. In this case report, we present an adolescent girl with IC that is successfully treated with aripiprazole, an antipsychotic. She was diagnosed with IC and was prescribed aripiprazole 2.5 mg/d and her IC symptoms disappeared and never recurred over 6 months of follow-up. Her HLA typing showed HLA DQB1*03 haplotype. Case ReportĪ 16-year-old adolescent girl was consulted child and adolescent psychiatry outpatient clinic with complaint of sudden episodes of loss of muscle tone.

Various antidepressants are useful in the treatment of IC however, there is limited knowledge on the use of antipsychotics in the treatment of IC. Additionally, human leukocyte antigen (HLA) DQB1 alleles were shown to be related to IC. Emotional reactions may trigger IC episodes. On the other hand, isolated cataplexy (IC) (hereditary cataplexy) is defined as loss of muscle tone that is not accompanied by narcolepsy. Cataplexy is a clinical entity that is characterized by transient muscle tone loss that mostly occurring as a part of narcolepsy.

Cataplexy medication