Aktuelle Therapie der Narkolepsie

 

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Zusammenfassung

Die Behandlung der Narkolepsie hat durch die Verfügbarkeit neuer Medikamente in den letzten Jahren einen Wandel erfahren. Basierend auf der „International Classification of Sleep Disorders” (ICSD-2) der amerikanischen Academy of Sleep Medicine von 2005 werden die klinischen Symptome, Genetik, Pathophysiologie und das aktuelle diagnostische Vorgehen zusammengefasst und die aktuellen Therapiemöglichkeiten basierend auf den europäischen und deutschen Leitlinien dargestellt. Seitdem Natriumoxybat und Modafinil in der Behandlung der Narkolepsie zugelassen sind, haben sich die Empfehlungen für die Therapie verändert und ehemalige Medikamente der 1. Wahl sind nun erst zweitrangig in Betracht zu ziehen. Zur Therapie der Tagesschläfrigkeit als ein Hauptsymptom der Narkolepsie mit und ohne Kataplexien wird nun Modafinil, Methylphenidat und Natriumoxybat empfohlen, Amphetamine und Selegilin sind Medikamente der 2. Wahl. Die Europäische Leitlinie zur Therapie der Narkolepsie empfiehlt nun zur Therapie der Kataplexie Natriumoxybat und erst in zweiter Linie Antidepressiva, einschließlich Clomipramin und Selegilin. Auch zur Therapie des gestörten Nachtschlafes wird Natriumoxybat empfohlen und bietet so die beste Alternative zur Therapie aller Narkolepsiesymptome.

Abstract

Treatment for narcolepsy with and without cataplexy has changed in the last few years due to the availability of new drugs. This article recounts the clinical symptoms, pathophysiology, genetics and current diagnostic criteria as stated in the International Classification of Sleep Disorders (ICSD-2) by the American Academy of Sleep Medicine in 2005 and presents current therapeutic options based on the European and German guidelines. Since sodium oxybate and modafinil are available now, recommendations regarding the symptomatic treatment have changed and the former first-line drugs are now second choice. Recommended treatment for excessive daytime sleepiness as a major symptom of narcolepsy with or without cataplexy consists of modafinil, methylphenidate and sodium oxybate; the formerly recommended amphetamines and selegiline are now second choice. European treatment recommendations for cataplexy now list sodium oxybate as first choice and antidepressants, particularly clomipramine, and selegiline as second choice drugs. Disturbed night time sleep can also be treated with sodium oxybate, thus adding this new drug to the list of hypnotics that used to be the best option for all narcolepsy symptoms.

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PD Dr. Svenja Happe

Institut für Klinische Neurophysiologie Klinikum Bremen-Ost, Lehrkrankenhaus der Universität Göttingen

Züricher Str. 40

28325 Bremen

Email: Svenja.Happe@klinikum-bremen-ost.de