Narcolepsy/ADHD

Narcolepsy:

Narcolepsy is a chronic sleep disorder, or dyssomnia, characterized by an excessive urge to sleep in inappropriate times, such as while at work or at school. Narcoleptics usually experience disturbed nocturnal sleep and an abnormal daytime sleep pattern, which is often confused with insomnia. When a narcoleptic falls asleep they generally experience the REM stage of sleep within 10 minutes; whereas most people do not experience REM sleep until after 90 minutes.
                                                      ( or)
Narcolepsy is a sleep disorder that causes excessive sleepiness and frequent daytime sleep attacks.

Causes, incidence, and risk factors

Narcolepsy is a nervous system disorder, not a mental illness. Anxiety does not cause narcolepsy.

Experts believe that narcolepsy is caused by reduced amounts of a protein called hypocretin, which is made in the brain. What causes the brain to produce less of this protein is unclear.

Narcolepsy tends to run in families.

Conditions that cause insomnia, such as disrupted work schedules, can make narcolepsy worse.

Symptoms

The most common symptoms of narcolepsy are:

• Periods of extreme drowsiness every 3 to 4 hours during the day. You may feel a strong urge to sleep, often followed by a short nap (sleep attack).
  • These periods last for about 15 minutes each, although they can be longer.
  • They often happen after eating, but may occur while driving, talking to someone, or during other situations.
  • You wake up feeling refreshed.
• Dream-like hallucinations may occur during the stage between sleep and wakefulness. They involve seeing or hearing, and possibly other senses.
• Sleep paralysis is when you are unable to move when you first wake up. It may also happen when you first become drowsy.
• Cataplexy is a sudden loss of muscle tone while awake, resulting in the inability to move. Strong emotions, such as laughter or anger, will often bring on cataplexy.
  • Most attacks last for less than 30 seconds and can be missed.
  • Your head will suddenly fall forward, your jaw will become slack, and your knees will buckle.
  • In severe cases, a person may fall and stay paralyzed for as long as several minutes.

Not all patients have all four symptoms.

Attention deficit hyperactivity disorder (ADHD):

ADHD is a problem with inattentiveness, over-activity, impulsivity, or a combination. For these problems to be diagnosed as ADHD, they must be out of the normal range for a child's age and development.

Causes, incidence, and risk factors

ADHD is the most commonly diagnosed behavioral disorder of childhood. It affects about 3 - 5% of school aged children. ADHD is diagnosed much more often in boys than in girls.

ADHD may run in families, but it is not clear exactly what causes it. Whatever the cause may be, it seems to be set in motion early in life as the brain is developing. Imaging studies suggest that the brains of children with ADHD are different from those of other children.

Depression, lack of sleep, learning disabilities, tic disorders, and behavior problems may be confused with, or appear with, ADHD. Every child suspected of having ADHD should be carefully examined by a doctor to rule out possible other conditions or reasons for the behavior.

Most children with ADHD also have at least one other developmental or behavioral problem. They may also have a psychiatric problem, such as depression or bipolar disorder.

Symptoms

The symptoms of ADHD fall into three groups:

• Lack of attention (inattentiveness)
• Hyperactivity
• Impulsive behavior (impulsivity)

Some children with ADHD primarily have the inattentive type. Others may have a combination of types. Those with the inattentive type are less disruptive and are more likely to not be diagnosed with ADHD.

ANTINARCOLEPTIC (eg, sodium oxybate): While its mechanism of action is unknown, sodium oxybate is a CNS depressant that alleviates excessive daytime sleepiness and cataplexy in narcolepsy.


WAKEFULNESS-PROMOTER (eg, modafinil): 
Modafinil is a selective, non-amphetamine wakefulness-promoting agent. It reduces excessive daytime sleepiness seen in narcolepsy without inducing anxiety or physical symptoms of CNS stimulation such as palpitations and hyperkinesias that are commonly caused by CNS stimulants. Modafinil is also indicated for treating shift work sleep disorder and obstructive sleep apnea/hypopnea syndrome.


Attention deficit hyperactivity disorder (ADHD)
Drug therapy should be used only for those patients who fail to respond to nonpharmacologic measures.

CNS STIMULANTS: The exact mechanism of action of CNS stimulants (eg, amphetamine, dextroamphetamine, methylphenidate) in the treatment of ADHD is unknown. However, it is believed that these agents block the reuptake of norepinephrine and dopamine into the presynaptic neuron and increase the release of these monoamines into the extraneuronal space. Given chronically in low doses, CNS stimulants improve symptoms in several weeks. Those patients who respond may need long-term treatment (up to approximately 10 years of age). The drugs should be withdrawn gradually once per year to determine if therapy is still necessary.

SELECTIVE NOREPINEPHRINE REUPTAKE INHIBITOR (eg, atomoxetine): 
Atomoxetine is a selective inhibitor of pre-synaptic norepinephrine transport mechanisms that reduces ADHD signs and symptoms. It may be discontinued without tapering the dose.