Editorials

Prescribing sodium oxybate for narcolepsy

BMJ 2016; 353 doi: https://doi.org/10.1136/bmj.i2367 (Published 28 April 2016) Cite this as: BMJ 2016;353:i2367
  1. Adam Zeman, chair of cognitive and behavioural neurology1,
  2. Zenobia Zaiwalla, , consultant neurophysiologist and non-respiratory sleep disorder lead clinician2
  1. 1University of Exeter Medical School, Exeter, Devon EX1 2LU, UK
  2. 2John Radcliffe Hospital, Oxford OX3 9DU, UK
  1. Correspondence to: A Zeman a.zeman{at}exeter.ac.uk

Demanding that a patient’s need is “exceptional” is irrational and should be abandoned

Narcolepsy affects around 4 in 10 000 people, making it about one quarter as common as multiple sclerosis in the United Kingdom.1 Its cardinal features are excessive daytime sleepiness causing frequent, irresistible naps; cataplexy, leading to collapse, embarrassment, and sometimes injury; and marked disturbance of nocturnal sleep. It is usually due to a specific deficiency of the hypothalamic neurotransmitter hypocretin and most often starts in the teens, probably as the result of an autoimmune process. Narcolepsy is far more than an occasional dose of sleepiness: it is a lifelong, pervasive, and potentially disabling disorder with a similar effect on quality of life to treatment resistant epilepsy.2

While potentially disabling, it is also highly treatable.3 A combination of stimulants (typically modafinil or dexamfetamine or both) and antidepressants (to reduce cataplexy) improves symptoms appreciably in most patients. But treatment response may be partial; contraindications or side effects can prevent their use; and none of these drugs deals with the third cardinal symptom of narcolepsy, which is sometimes the most distressing—the fragmentation of nocturnal …

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