Is Sodium Oxybate a solution for Narcolepsy?
What is narcolepsy?
Narcolepsy is a disease which causes someone to fall asleep suddenly many times during the day. It is a neurological disorder caused by a brain malfunction.
Narcolepsy is a loss of cells in a particular part of the brain called hypothalamus that orchestrates sleep and wake cycles, however due to the loss there is no constant sleep -wake routine.
Everybody goes through REM (Rapid eye movement) and NREM (non-rapid eye movement) it’s a cycle that occurs four to five times during sleep. Normal people go into REM after 80-100mintues of NREM but narcoleptic patients go into REM straight away this is because of a lack of neurotransmitters in the brain which are thought to connect with each other to control process in the brain .
Recent studies have linked it to specific hormone called hypocretin which control movement in the hypothalamus is the hormone that is lacking in the brain; figure one Is showing the hypothalamus of a normal and a narcoleptic brain with the dispersal of hypocretin. Image A shows a normal brain there is more hypocretin present, image D is a narcoleptic brain it shows hypocretin is lacking. Scientists are working on a treatment to increase hypocretin levels narcoleptic patients to diminish other narcoleptic problems
When narcoleptic patients do fall asleep they do not get good amount of sleep and can wake up many times during the night therefore sleep intrudes during them during the day.
Narcolepsy is a condition that affects approximately .05% of the population. In the UK that means 25,000 people are affected by Narcolepsy, which is almost the same figure as those affected by Type 2 Diabetes[2].Narcolepsy is not only common in humans but similarly in animals too such as cats, dogs and rabbits.
Symptoms
Excessive day time sleepiness-feeling sleepy during the day
Sleep paralysis – not being able to move whilst conscience
Cataplexy-muscle weakness
Hallucination –intense dreams, sometimes frightening occur between sleep and wakefulness Micro sleep- not enough sleep
Disrupted night time sleep Narcolepsy can also effects people’s lifestyle everyday activity can become dreadful this can lead to depression and other psychological problems
Sodium Oxybate (Xyrem)
What is cataplexy? Cataplexy, the loss of skeletal muscle tone without loss of consciousness, is one of the defining symptoms of a puzzling neurological disorder called narcolepsy. The cataplectic attacks of narcolepsy are frequently prompted by laughter; other times, embarrassment, social interactions with strangers, sudden anger, athletic exertion or sexual intercourse may trigger an episode.[4]
Sodium oxybate (Xyrem). Sodium oxybate (Xyrem), also referred to as gamma hydroxybutyrate (GHB), helps reduce the frequency of cataplexy attacks and improve daytime sleepiness[1]
Sodium Oxybate received approval in 2002 for cataplexy to reduce muscle weakness for those that have narcolepsy. However this drug is only tolerable for some patients and for others it comes with much threat due to the serious side effects of hallucinations, agitation, severe mental confusion, abnormal thinking, disrupted sleep, and depression.
Xyrem trial
There are many trials for sodium Oxybate however I have chosen one that was published by the UKMI (UK medicine information) to help support new medicine entry in the NHS which was published in 2006.
A study was carried out by the multi study group conductor with 136 patients in a four-week, double blind controlled process. Which were all over the age of 18, and had the mean range age of 43, 42% being male and 92% being Caucasian.
From a range of 3 to 249 cataplexy attacks a week a median was picked out to be 21 attacks per week. To investigate how effective sodium Oxybate can be, different amounts off sodium Oxybate were trialled. From the 136 patients 34 were on the placebo, 34 patients were on 3 grams, 33 patients on 6grams and 35 were on 9
