Clinical and Therapeutic Aspects of Childhood Narcolepsy-Cataplexy: A Retrospective Study of 51 Children

Abstract

this study reports on the clinical features of childhood narcolepsy and documents the safe use of treatments commonly used in adults in young children.

Current Treatment of Selected Pediatric Sleep Disorders

“…That report found no impact of the use of sodium oxybate on the occurrence of subsequent puberty. The authors also reported that sodium oxybate alone, or in association with one other drug, modafinil, was sufficient treatment in half of prepubertal cases of narcolepsy-cataplexy [60]. Other published retrospective series reporting the use of GHB in pediatric narcolepsycataplexy have shown similar efficacy and tolerance [88,89].…”

“…In this way, it has been argued that pediatric narcolepsy with cataplexy often co-occurs with a complex movement disorder at disease onset, a phenomenon that may vanish later in the course of the disease [59]. Pediatric narcolepsy-cataplexy is also associated with excessive weight gain near symptom onset, and may be associated with other sleep disorders, including periodic limb movements and sleep apnea, which may obscure or delay the correct clinical diagnosis [60,61].…”

“…Despite this, most published adverse drug reactions have not been serious [74,75], and the use of modafinil has been reported in the treatment of EDS in narcoleptic children [60,76,77]. Off-label use of the drug has also been reported in ADHD to be effective and well tolerated [78][79][80][81].…”

“…The improvement in cataplexy is much more rapid than the effect on daytime sleepiness, which may take up to 6-8 weeks. In a pediatric narcolepsy series, 85 % of children (similar rates for pre, peri, and post pubertal children) were treated with sodium oxybate with a reportedly high positive effect on daytime sleepiness, disturbed nighttime sleep, and cataplexy [60]. Irritability and nausea were commonly reported side effects.…”

“…The most commonly used drug in this class is venlafaxine at typical doses of 75-150 mg daily (as low as 37.5 mg in younger pediatric patients). Recent data in children with narcolepsy-cataplexy demonstrates reasonable retention rate (68 %) and good efficacy for cataplexy, with frequent side effects of irritability and weight gain reported both in pre-(18 %) and peri/post-(29 %) pubertal groups [60]. Atomoxetine, a highly specific noradrenergic reuptake blocker, has also been effective for treatment of cataplexy as well as EDS in adults and children, and may be useful in resistant cataplexy at doses of 18-100 mg in one or two divided doses [90,91].…”