Ahmed Arshia, Tariq Sara, Khan Salman J, Shah Zia H
Internal Medicine, Guthrie Lourdes Hospital, Binghamton, USA.
Public Health, University of Massachusetts Amherst, Amherst, USA.
Cureus. 2024 Dec 26;16(12):e76437. doi: 10.7759/cureus.76437. eCollection 2024 Dec.
In narcolepsy with cataplexy, sodium oxybate and the recently FDA-approved drug pitolisant are preferred medications. Armodafinil, a longer-acting, non-amphetamine stimulant, is often used in patients who have narcolepsy without cataplexy. It enhances alertness by increasing presynaptic dopamine transmission presynaptically, amplifying serotonin in the cerebral cortex, activating glutamatergic circuits, which may contribute to its vigilance-enhancing properties, and stimulating orexin activity. Armodafinil alone is approved for excessive daytime sleepiness (EDS) symptoms. We report this case of narcolepsy with cataplexy, where armodafinil alone improved the symptoms of not only EDS but also cataplexy. It is known that sodium oxybate, through its gamma-aminobutyric acid type B (GABA-B) receptor agonist activity, helps in cataplexy and EDS. However, in some instances, like this patient, armodafinil alone improves the symptoms of cataplexy and maintains wakefulness.
在发作性睡病伴猝倒症中，羟丁酸钠和最近获得美国食品药品监督管理局（FDA）批准的药物匹莫林是首选药物。阿莫达非尼是一种作用时间更长的非苯丙胺类兴奋剂，常用于没有猝倒症的发作性睡病患者。它通过增加突触前多巴胺传递、增强大脑皮层中的血清素、激活谷氨酸能回路（这可能有助于其提高警觉性的特性）以及刺激食欲素活性来提高警觉性。阿莫达非尼单独被批准用于治疗白天过度嗜睡（EDS）症状。我们报告了这例发作性睡病伴猝倒症的病例，其中单独使用阿莫达非尼不仅改善了EDS症状，还改善了猝倒症状。已知羟丁酸钠通过其γ-氨基丁酸B型（GABA-B）受体激动剂活性，有助于治疗猝倒症和EDS。然而，在某些情况下，如该患者，单独使用阿莫达非尼可改善猝倒症状并维持清醒状态。
