Narcolepsy is a condition which does not go away. Currently, there is no cure but symptoms can be effectively managed. The cure is not possible due to irreversible damage to neurons present in the hypothalamus.
Can Narcolepsy Go Away On Its Own?
Narcolepsy is a chronic neurological condition. This condition does not go away and can only be managed through medication. Fortunately, the condition is non-progressive or has slow progression and symptoms do not worsen in most of the patients.
Narcolepsy is the condition probably caused due to immune system triggered throug various means such as infection. As the infection contracts the body, it stimulates the immune system to kill the healthy brain cells. Thus, the immune system targets the neurons of the hypothalamus. These neurons are known to secrete hypocretin (also known as orexin). Hypocretin is a chemical that regulates the sleep-wake cycle. Damage to the neurons secreting hypocretin reduces its concentration in the cerebrospinal fluid; as the condition progresses, almost 60000 to 70000 neurons of the hypothalamus get destroyed1.
The level of hypocretin reaches to level zero because of the complete destruction of hypothalamus neurons. The level of hypocretin in cerebrospinal fluid is diagnosed with a technique known as lumbar puncture.
The person who has zero hypocretin level in the cerebrospinal fluid suffered from cataplexy. This is the condition characterized by weak muscle tone. The muscular weakness is severe and the patient falls on the floor without losing conciousness2.
It is to be noted that the regeneration of neurons is a very rare phenomenon. Thus, once the hypocretin-producing neurons of the hypothalamus get damaged, they cannot be revived. This makes this condition permanent. Further, the condition should also be managed through persistent treatment.
Research is on to either slow or prevent the destruction of hypothalamus cells and regenerate them. Growth of hypothalamus neurons though stem cells is another possibility in the near future. However, in the present scenario, narcolepsy remains a chronic condition which remains forever with the patient.
Treatment Of Narcolepsy
Various treatment options are available for the patients to manage the symptoms of narcolepsy. A most common symptom of narcolepsy includes excessive daytime sleepiness, cataplexy, behavioral changes, and hallucinations. On the basis of the severity of symptoms, the treatment strategy is designed. The proper treatment strategy is a must to prevent the patient to encounter fatal accidents. Many countries have restrictions on granting the driving license to patients with poorly managed narcolepsy.
Following are the various treatments that can be implemented in narcolepsy:
Antidepressants. Tricyclic antidepressants such as imipramine, desipramine, and clomipramine are used to control the depression. These drugs are also effective in controlling symptoms of cataplexy3. Antidepressant may not be tolerable to some patients due to its side effects.
Amphetamine-Like Stimulants. When modafinil and armodafinil are not effective in treating narcolepsy, the doctor may prescribe amphetamine-like stimulants such as methylphenidate3. These drugs are used to alleviate excessive day time sleepiness. The use of these drugs should be monitored due to their side effects. Common side effects include disruption in cardiac rhythm, disturbance in nighttime sleep, irritability and nervousness.
Modafinil. Modafinil and armodafinil are generally prescribed as stimulants to prevent day time sleep. These are generally the primary treatment for narcolepsy. Non-additive and predictable pharmacokinetic profiles are some of the advantages of these stimulants over older stimulants4.
Sodium Oxybate. Sodium oxybate is used to prevent cataplexy and day time sleepiness5. The drug is also effective in promoting nighttime sleep. Day time sleepiness is more effectively controlled through high doses of this drug.
Immune system damages the hypothalamus neurons which are responsible for secreting hypocretin. This chemical controls sleeping behavior. Various treatment options are available for treating narcolepsy such as antidepressants, stimulants, amphetamine-like stimulants and sodium oxybate.
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