some require proof by MSTL or Orexin levels and some do not). On the others hand, some old classifications have used the previous terms “Type 1 Narcolepsy” for narcolepsy with cataplexy, and “Type 2 Narcolepsy” for narcolepsy without demonstrated cataplexy: this classification appears redundant and has ambiguities (e.g. This accentuates the need for proposing two new terms, namely “primary narcolepsy” for the most common narcolepsy condition that appears to be hypothalamically linked to an auto-immune process involving hypocretin, and “symptomatic narcolepsy” due to infectious or tumor or trauma events involving the hypocretin / reticular activating system/ hypothalamus. I suggest a new model of hypocretin deficiency being slightly down-stream from the actual cause of narcolepsy-cataplexy. These may reflect multifactorial etiologies: some of these may be linked with narcolepsy, and others unassociated. Fourth, the comorbidities of narcolepsy might include psychosis, anxiety, depression, impaired functioning, and seizure phenomena.These historical rankings and screens combined with proper HLA screening may be adequate for more than 90% of diagnoses. At this stage, we, at the PNI b apply modifications of the Epworth Sleepiness Scale in conjunction with the Fatigue Severity Scale, and the Neppe Narcolepsy Questionnaire, as fundamental ways to evaluate narcolepsy clinically. Third, clinical evaluations must be standardized.
#Narcolepsy without cataplexy plus
This is pertinent because, in the USA, insurance approval of costly medications such as modafinil, armodafinil and sodium oxybate are often dependent on the insurances applying a positive MSLT as a requirement when it is negative, the insurances might tragically deny coverage of these medications: This might deprive many in the narcolepsy population of their essential life-sustaining treatment, even though they might have definite clinical features plus the gene expression, and often, already, response to wakefulness drugs. Secondly, the multiple sleep-latency test (MSLT) may be overemphasized for definitive diagnosis, because the genetic test is as important or even more relevant.However, the DQA1*01:02 gene should also be measured 1:02. These genes include particularly DQB1*06:02. First, the genes for narcolepsy have been largely ignored when applying the recognized criteria for diagnosing narcolepsy.The classical standard narcolepsy research criteria confirming a narcolepsy diagnosis consist of either a positive multiple sleep-latency tests (MSLT), or an abnormally low cerebrospinal fluid (CSF) Orexin (hypocretin) level. Diplopia and nocturnal insomnia are two other often ignored common symptoms.
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