Archives

  • 2018-07
  • 2018-10
  • 2018-11
  • 2019-04
  • 2019-05
  • 2019-06
  • 2019-07
  • 2019-08
  • 2019-09
  • 2019-10
  • 2019-11
  • 2019-12
  • 2020-01
  • 2020-02
  • 2020-03
  • 2020-04
  • 2020-05
  • 2020-06
  • 2020-07
  • 2020-08
  • 2020-09
  • 2020-10
  • 2020-11
  • 2020-12
  • 2021-01
  • 2021-02
  • 2021-03
  • 2021-04
  • 2021-05
  • 2021-06
  • 2021-07
  • 2021-08
  • 2021-09
  • 2021-10
  • 2021-11
  • 2021-12
  • 2022-01
  • 2022-02
  • 2022-03
  • 2022-04
  • 2022-05
  • 2022-06
  • 2022-07
  • 2022-08
  • 2022-09
  • 2022-10
  • 2022-11
  • 2022-12
  • 2023-01
  • 2023-02
  • 2023-03
  • 2023-04
  • 2023-05
  • 2023-06
  • 2023-08
  • 2023-09
  • 2023-10
  • 2023-11
  • 2023-12
  • 2024-01
  • 2024-02
  • 2024-03
  • 2024-04

    • We know that the cost of modafinil therapy is very

    2018-10-26

    We know that the cost of modafinil therapy is very superior of the one with methyphenidate. The treatment option with methylphenidate in relation with modafinil must be taken based on clinical criteria, the safety of the treatment with sympathomimetic drugs, or the associated risks for every patient. In parallel, the association of drugs for the control of cataplexy must be evaluated in these cases [7–10]. In any case and independently of the pharmacological treatment of choice, there must be a regular patient follow up to verify the side effects, including sleep disturbances, humor changes, methabolic and cardiovascular abnormalities. This way, this gssg follow up is also important to determine treatment adherence and treatment response, monitor drug safety and be prepared to solve any social or occupational hazard that might appear during the course of treatment, when the symptoms of narcolepsy are not well controlled [8–10]. The choice for the treatment with modafinil must be done after a precise indication for the control of DES. Even though with the significant improvements on the understanding of narcolepsy׳s physiopathology, there is still no treatment that completely recovers and maintains awareness during the entire day [7,8]. In this context, initial and progressive doses and constant monitoring are essential, even though, modafinil is the drug with the safest profile compared to others. The regular follow up of the patient facilitates the identification of early complications with the discontinuation of modafinil, if necessary and the evaluation of the clinical response seems to be the correct way to manage the therapy.
    Conclusions
    Introduction Narcolepsy is a neurological disease characterized by diurnal excessive sleepiness, cataplexy, hypnagogic hallucinations sleep paralysis and sleep fragmentation. Patients show the first signs and symptoms between the first and second decade of life with a disease prevalence varying in the general populations between 0.025% and 0.05% [1]. Primary sleep diseases such as the restless leg syndrome and periodical leg movements (PLM) have been associated with narcolepsy [2]. However, we point out that the prevalence studies and the effects upon the periodical leg movements in patients with narcolepsy are limited and with conflicting results [3,4]. PLMs are rare among young people and are more common among the aged ones in the general population. PLMs are characterized by a short and rhythmic extension (duration of 0.5–10s), mainly in the legs, with a minimal series of 4 consecutive movements with intervals between 4 and 90s [5]. Frequently, PLMs are associated with awakenings and also with several sleep disorders including the restless leg syndrome, sleep obstructive apnea syndrome, sleep behavioral disorder of REM sleep, insomnia and narcolepsy [6]. The PLMs are considered normal in adults up to a frequency of 15 movements per hour during sleep. However, studies that evidentiated higher prevalence of PLM in patients with narcolepsy used the index of normalcy limit for PLM at the value of 5 per hour [2,3,7–9].
    Methodology We have revised the files of 59 patients with clinical and electrophysiological diagnosis of narcolepsy according to gssg the American Academy of Sleep Medicine, who were treated at the outpatient facility of Diurnal Excessive Sleepiness of the Federal University of São Paulo [10,11]. All patients were treated between 2003 and 2013. This article was approved by the Ethical Research Committee of the Federal University of São Paulo (1802/07). Patients were considered as having PLM when five or more movements per hour were present according to the criteria utilized by previous articles about the same topic [2,3,8].
    Statistics The value of p<0.05 was considered as significant. The confidence interval was of 95%.
    Discussion Worsening on the sleep architecture in PLMs patients has been well described with increase in the index of awakenings higher than 5 per hour, associated with PLMs. This limit of 5 per hour index for PLMs to separate normalcy from disorder, is supported by a cohort study of 503 patients performed by Harsh and cols. This study demonstrated a lower sleep efficiency with higher index of awakenings in patients with narcolepsy and PLMs above 5 movements per hour [12]. The increase in the prevalence of PLMs leads to a negative impact upon the quality of sleep and worsens even more than the diurnal somnolence in these patients. The increase of the awakening indexes and superficial sleep stages are already part of the REM sleep instability phenomena frequently described in narcolepsy, which worsens even more during PLMs, leading to a further reduction of the sleep efficiency [7,13].