Treatment paradigms for cataplexy in narcolepsy: past, present, and future

Todd J Swick1–4 1Department of Neurology, University of Texas School of Medicine-Houston, Houston; 2The Sleep Center at North Cypress Medical Center, Cypress; 3Apnix Sleep Diagnostics, Houston; 4Neurology and Sleep Medicine Consultants, Houston, TX, USA Abstract: Cataplexy is defined as ep...

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Autor principal:	Swick TJ
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2015
Materias:	cataplexy narcolepsy treatment sodium oxybate antidepressants emerging therapies Psychiatry RC435-571 Neurophysiology and neuropsychology QP351-495
Acceso en línea:	https://doaj.org/article/e59e4691809f476ab57e643e438964cf
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spelling	oai:doaj.org-article:e59e4691809f476ab57e643e438964cf2021-12-02T06:36:07ZTreatment paradigms for cataplexy in narcolepsy: past, present, and future1179-1608https://doaj.org/article/e59e4691809f476ab57e643e438964cf2015-12-01T00:00:00Zhttps://www.dovepress.com/treatment-paradigms-for-cataplexy-in-narcolepsy-past-present-and-futur-peer-reviewed-article-NSShttps://doaj.org/toc/1179-1608Todd J Swick1–4 1Department of Neurology, University of Texas School of Medicine-Houston, Houston; 2The Sleep Center at North Cypress Medical Center, Cypress; 3Apnix Sleep Diagnostics, Houston; 4Neurology and Sleep Medicine Consultants, Houston, TX, USA Abstract: Cataplexy is defined as episodes of sudden loss of voluntary muscle tone triggered by emotions generally lasting <2 minutes. Cataplexy is most commonly associated with and considered pathognomonic for narcolepsy, a sleep disorder affecting ~0.05% of the general population. Knowledge of the pathophysiology of cataplexy has advanced through study of canine, murine, and human models. It is now generally considered that loss of signaling by hypothalamic hypocretin/orexin-producing neurons plays a key role in the development of cataplexy. Although the cause of hypocretin/orexin neuron loss in narcolepsy with cataplexy is unknown, an autoimmune etiology is widely hypothesized. Despite these advances, a literature review shows that treatment of cataplexy remains limited. Multiple classes of antidepressants have been commonly used off-label for cataplexy in narcolepsy and are suggested for this use in expert consensus guidelines based on traditional practice, case reports, and small trials. However, systematic research evidence supporting antidepressants for cataplexy is lacking. The single pharmacotherapy indicated for cataplexy and the guideline-recommended first-line treatment in Europe and the US is sodium oxybate, the sodium salt of gamma-hydroxybutyrate. Clinical trial evidence of its efficacy and safety in cataplexy is robust, and it is hypothesized that its therapeutic effects may occur through gamma-aminobutyric acid receptor type B-mediated effects at noradrenergic, dopaminergic, and thalamocortical neurons. Additional possible mechanisms for cataplexy therapy suggested by preliminary research include antagonism of the histamine H3 autoreceptor with pitolisant and intravenous immunoglobulin therapy for amelioration of the presumed autoimmune-mediated hypocretin/orexin cell loss. Further research and development of therapeutic approaches to cataplexy are needed. Keywords: cataplexy, narcolepsy, treatment, sodium oxybate, antidepressants, emerging therapiesSwick TJDove Medical Pressarticlecataplexynarcolepsytreatmentsodium oxybateantidepressantsemerging therapiesPsychiatryRC435-571Neurophysiology and neuropsychologyQP351-495ENNature and Science of Sleep, Vol 2015, Iss Issue 1, Pp 159-169 (2015)
institution	DOAJ
collection	DOAJ
language	EN
topic	cataplexy narcolepsy treatment sodium oxybate antidepressants emerging therapies Psychiatry RC435-571 Neurophysiology and neuropsychology QP351-495
spellingShingle	cataplexy narcolepsy treatment sodium oxybate antidepressants emerging therapies Psychiatry RC435-571 Neurophysiology and neuropsychology QP351-495 Swick TJ Treatment paradigms for cataplexy in narcolepsy: past, present, and future
description	Todd J Swick1–4 1Department of Neurology, University of Texas School of Medicine-Houston, Houston; 2The Sleep Center at North Cypress Medical Center, Cypress; 3Apnix Sleep Diagnostics, Houston; 4Neurology and Sleep Medicine Consultants, Houston, TX, USA Abstract: Cataplexy is defined as episodes of sudden loss of voluntary muscle tone triggered by emotions generally lasting <2 minutes. Cataplexy is most commonly associated with and considered pathognomonic for narcolepsy, a sleep disorder affecting ~0.05% of the general population. Knowledge of the pathophysiology of cataplexy has advanced through study of canine, murine, and human models. It is now generally considered that loss of signaling by hypothalamic hypocretin/orexin-producing neurons plays a key role in the development of cataplexy. Although the cause of hypocretin/orexin neuron loss in narcolepsy with cataplexy is unknown, an autoimmune etiology is widely hypothesized. Despite these advances, a literature review shows that treatment of cataplexy remains limited. Multiple classes of antidepressants have been commonly used off-label for cataplexy in narcolepsy and are suggested for this use in expert consensus guidelines based on traditional practice, case reports, and small trials. However, systematic research evidence supporting antidepressants for cataplexy is lacking. The single pharmacotherapy indicated for cataplexy and the guideline-recommended first-line treatment in Europe and the US is sodium oxybate, the sodium salt of gamma-hydroxybutyrate. Clinical trial evidence of its efficacy and safety in cataplexy is robust, and it is hypothesized that its therapeutic effects may occur through gamma-aminobutyric acid receptor type B-mediated effects at noradrenergic, dopaminergic, and thalamocortical neurons. Additional possible mechanisms for cataplexy therapy suggested by preliminary research include antagonism of the histamine H3 autoreceptor with pitolisant and intravenous immunoglobulin therapy for amelioration of the presumed autoimmune-mediated hypocretin/orexin cell loss. Further research and development of therapeutic approaches to cataplexy are needed. Keywords: cataplexy, narcolepsy, treatment, sodium oxybate, antidepressants, emerging therapies
format	article
author	Swick TJ
author_facet	Swick TJ
author_sort	Swick TJ
title	Treatment paradigms for cataplexy in narcolepsy: past, present, and future
title_short	Treatment paradigms for cataplexy in narcolepsy: past, present, and future
title_full	Treatment paradigms for cataplexy in narcolepsy: past, present, and future
title_fullStr	Treatment paradigms for cataplexy in narcolepsy: past, present, and future
title_full_unstemmed	Treatment paradigms for cataplexy in narcolepsy: past, present, and future
title_sort	treatment paradigms for cataplexy in narcolepsy: past, present, and future
publisher	Dove Medical Press
publishDate	2015
url	https://doaj.org/article/e59e4691809f476ab57e643e438964cf
work_keys_str_mv	AT swicktj treatmentparadigmsforcataplexyinnarcolepsypastpresentandfuture
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Treatment paradigms for cataplexy in narcolepsy: past, present, and future

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