#IDEOPATHIC HUPERSOMNIA HYPNOGRAM UPDATE#
Our update is limited to these options, and to some still unproven or insufficiently validated new approaches. Lifestyle advice and pharmacological therapy are the two treatment modalities most commonly used for the treatment of IH. A start in (early) childhood is even more detrimental, since it has additional negative impact on social development and achievements at school. Those with the type with prolonged nighttime sleep additionally have difficulty rising in the morning making it difficult to fit in educational programs or to work starting (early) in the morning. IH is an incapacitating disorder with profound impact on daytime performance and quality of life. Where relevant, we will describe the efficacy of treatment for both phenotypes separately. The criteria for diagnosing IH are as shown in Table 1. In this review, we use the criteria of the third and current edition of the classification, the ICSD-3. Unfortunately, there is an additional problem with the phenotype characterized by an inability to stay awake there are no generally accepted criteria to separate this from chronic sleep deprivation, and in recent years, it has become clear that the delineation from narcolepsy type 2 (NT2) is problematic. It seems probable that multiple pathophysiological pathways may result in each of the phenotypes.
However, neither is there evidence that they share a common pathophysiology. This seems to have happened because there is no evidence that the various phenotypes have different underlying pathophysiologies. In the current classification, they are described together. Later, another phenotype was added that was better characterized by an inability to stay awake during the waking part of the day than by an increased amount of sleep. In the early years, the “classical type” of IH was defined as increased need for sleep over the 24 h of the day, with prolonged duration of nighttime sleep. It may also have prevented us gaining knowledge about the pathophysiology and the best treatment options. This has unintentionally led to much confusion about this rare and poorly understood disorder. The diagnostic criteria for idiopathic hypersomnia (IH), as defined in the three editions of the International Classification of Sleep Disorders (ICSD) published between 19, have changed considerably over the years. In the future, newer drugs such as sodium oxybate, pitolisant, and solriamfetol might be authorized for use in idiopathic hypersomnia. Methylphenidate and dexamphetamine are good alternatives. Since the efficacy of modafinil is consistently described and there is much experience with this substance, it is reasonable to start with modafinil as a first choice treatment. ConclusionĮvidence on treatment is scarce. The few treatment studies that have been performed are hampered by small sample sizes and the use of variable and often insufficiently validated outcome parameters for the whole spectrum of idiopathic hypersomnia symptoms. Additional pharmacological treatment is therefore usually initiated. Recent FindingsĮvidence for non-pharmacological interventions is lacking improvement in symptoms on introducing these interventions is often less pronounced than in narcolepsy. We present an update on the evidence concerning treatment options for idiopathic hypersomnia. The most commonly used treatment modalities are lifestyle advice and pharmacological therapy. Idiopathic hypersomnia is an incapacitating disorder with a profound impact on daytime performance and quality of life.
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