21913_Narcolepsy_in_Children_Overcoming_Barriers_and_Improving_Outcomes

Narcolepsy in Children

Narcolepsy is a lifelong neurologic disorder characterized by excessive daytime sleepiness and an imbalance in REM mediated sleep-wake physiology. This imbalance may lead to other signs of narcolepsy, including sleep paralysis, hypnogogic hallucinations, and cataplexy. Childhood onset of disease is common, with onset prior to 15 years of age in one-third of patients, and prior to 5 years of age in 5 percent. Despite early onset of symptoms, children often go undiagnosed and untreated for many years, with some studies indicated a median time to diagnosis as long as 10 years. Given the vital period for academic and personal development during childhood, a lack of timely diagnosis and treatment may translate into a lifetime of consequences, including poor academic achievement, obesity, social marginalization, and excessive dependency on caregivers. Clearly, the need to identify children early is vital in order to appropriately diagnose and treat narcolepsy.

Nondrug treatment includes good sleep hygiene with regular sleep and wake times with the aim to provide adequate hours of nighttime sleep. Total sleep time requirement varies by age; although 7-8 hours is recommended for adults, children need more sleep. In addition, regular exercise improves the sleeping pattern. Scheduled brief naps are one of the most effective nondrug treatments for excessive daytime sleepiness; however, they are seldom sufficient on their own and are often impractical in older children. Nondrug treatment for cataplexy includes family support and education about the triggers and the nature of the episodes. Wake-promoting drugs include modafinil and armodafinil; however, these agents are not FDA-approved for children younger than 17 years. Stimulants such as methylphenidate and amphetamine can be useful in the management of narcolepsy due to their wake-promoting properties. The FDA has recently approved sodium oxybate for the treatment of cataplexy or excessive daytime sleepiness (EDS) in patients 7 years of age or older with narcolepsy, based on the completion of a randomized, placebo-controlled study.

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