European guideline and expert statements on the management of narcolepsy in adults and children.

Abstract

BACKGROUND AND PURPOSE:

Narcolepsy is an uncommon hypothalamic disorder of presumed autoimmune origin that usually requires lifelong treatment. This paper aims to provide evidence-based guidelines for the management of narcolepsy in both adults and children.

METHODS:

The European Academy of Neurology (EAN), European Sleep Research Society (ESRS), and European Narcolepsy Network (EU-NN) nominated a task force of 18 narcolepsy specialists. According to the EAN recommendations, 10 relevant clinical questions were formulated in PICO format. Following a systematic review of the literature (performed in Fall 2018 and updated in July 2020) recommendations were developed according to the GRADE approach.

RESULTS:

A total of 10,247 references were evaluated, 308 studies were assessed and 155 finally included. The main recommendations can be summarized as follows: (i) excessive daytime sleepiness (EDS) in adults-scheduled naps, modafinil, pitolisant, sodium oxybate (SXB), solriamfetol (all strong); methylphenidate, amphetamine derivatives (both weak); (ii) cataplexy in adults-SXB, venlafaxine, clomipramine (all strong) and pitolisant (weak); (iii) EDS in children-scheduled naps, SXB (both strong), modafinil, methylphenidate, pitolisant, amphetamine derivatives (all weak); (iv) cataplexy in children-SXB (strong), antidepressants (weak). Treatment choices should be tailored to each patient's symptoms, comorbidities, tolerance and risk of potential drug interactions.

CONCLUSION:

The management of narcolepsy involves non-pharmacological and pharmacological approaches with an increasing number of symptomatic treatment options for adults and children that have been studied in some detail.

• Authors: Claudio L A Bassetti, Ulf Kallweit, Luca Vignatelli, Giuseppe Plazzi, Michel Lecendreux, Elisa Baldin, Leja Dolenc-Groselj, Poul Jennum, Ramin Khatami, Mauro Manconi, Geert Mayer, Markku Partinen, Thomas Pollmächer, Paul Reading, Joan Santamaria, Karel Sonka, Yves Dauvilliers, Gert J Lammers
• Journal: Journal of sleep research (J Sleep Res) Vol. 30 Issue 6 Pg. e13387 (12 2021) ISSN: 1365-2869 [Electronic] England
• PMID: 34173288 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't, Review, Systematic Review)
• Copyright: © 2021 The Authors. Journal of Sleep Research published by John Wiley & Sons Ltd on behalf of European Academy of Neurology and European Sleep Research Society.

Chemical References

• Sodium Oxybate
• Modafinil

Topics

• Adult
• Cataplexy
• Child
• Humans
• Modafinil (therapeutic use)
• Narcolepsy (diagnosis, drug therapy)
• Sleep
• Sodium Oxybate (therapeutic use)