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发作性睡病的治疗。

Treatment of narcolepsy.

作者信息

Didato Giuseppe, Nobili Lino

机构信息

Centro per la Chirurgia dell'Epilessia e del Parkinson Claudio Munari, Ospedale Niguarda Ca' Granda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy.

出版信息

Expert Rev Neurother. 2009 Jun;9(6):897-910. doi: 10.1586/ern.09.29.

Abstract

Narcolepsy is a neurological disorder characterized, in its classical form, by excessive daytime sleepiness (EDS) with irresistible episodes of sleep, cataplexy, disrupted nocturnal sleep, hypnagogic/hypnopompic hallucinations and sleep paralysis. It is often under-diagnosed, however, if it is suitably diagnosed, symptoms can be well treated by means of targeted drugs, such as modafinil to treat EDS, sodium oxybate for cataplexy, as well as EDS and disrupted nocturnal sleep, and tricyclic and newer antidepressants for cataplexy. Hallucinations and sleep paralysis can be treated with the same drugs used for cataplexy. Amphetamines and amphetamine-like stimulants are used less nowadays. Behavioral measures are also important and useful. The discovery of hypocretin deficiency in narcoleptic patients opens new perspectives for the development of newer therapeutic approaches for both EDS and cataplexy. Therapy for narcolepsy is chronic, hence symptomatic. However, the correct use of available drugs enables patients to gain a better quality of life, keeping the symptoms under control, which, mainly from a social point of view, are heavily disabling.

摘要

发作性睡病是一种神经系统疾病,其典型形式的特征为日间过度嗜睡(EDS),伴有不可抗拒的睡眠发作、猝倒、夜间睡眠紊乱、入睡前/觉醒前幻觉和睡眠瘫痪。然而,它常常被漏诊。不过,如果得到恰当诊断,症状可以通过靶向药物得到很好的治疗,比如用莫达非尼治疗日间过度嗜睡,用羟丁酸钠治疗猝倒以及日间过度嗜睡和夜间睡眠紊乱,用三环类和新型抗抑郁药治疗猝倒。幻觉和睡眠瘫痪可用治疗猝倒的相同药物进行治疗。如今,苯丙胺和类苯丙胺兴奋剂的使用较少。行为措施也很重要且有用。发作性睡病患者中下丘脑分泌素缺乏的发现为开发针对日间过度嗜睡和猝倒的新型治疗方法开辟了新的前景。发作性睡病的治疗是长期性的,因此是对症治疗。然而,正确使用现有药物能使患者获得更好的生活质量,控制住症状,而这些症状主要从社会角度来看会严重致残。

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