Central nervous system narcolepsy

Substance-Induced Anxiety Disorder. Numerous medicines and drugs of abuse can produce panic attacks. Panic attacks can be triggered by central nervous system stimulants such as cocaine, methamphetamine, caffeine, over-the-counter herbal stimulants such as ephedra, or any of the medications commonly used to treat narcolepsy and ADHD, including psychostimulants and modafinil. Thyroid supplementation with thyroxine (Synthroid) or triiodothyronine (Cytomel) can rarely produce panic attacks. Abrupt withdrawal from central nervous system depressants such as alcohol, barbiturates, and benzodiazepines can cause panic attacks as well. This can be especially problematic with short-acting benzodiazepines such as alprazolam (Xanax), which is an effective treatment for panic disorder but which has been associated with between dose withdrawal symptoms. 

Recently developed drugs, known as ampakines, have been clinically shown to enhance learning and memory skills. These "smart pills" are being developed as a possible treatment for narcolepsy, attention deficit disorder, and Alzheimer s disease. Once approved by the FDA, physicians can prescribe them for off-label uses, such as jet lag or age-related forgetfulness.These agents act primarily within the central nervous system (brain and spinal cord), and they do not cause the jitteriness commonly associated with caffeine or amphetamines. 

Ephedrine, given im/iv/sc, is indicated for the treatment of acute hypotensive states, treatment of Adams-Stokes syndrome with complete heart block, stimulation of the central nervous system (CNS) to combat narcolepsy and depressive states, treatment of acute bronchospasm, treatment of enuresis, and treatment of myasthenia gravis. When given in nasal form, ephedrine is used in the treatment of nasal congestion, promotion of nasal or sinus drainage, or relief of eustachian tube congestion. 

One of the oldest uses for dextroamphetamines is in the treatment of narcolepsy, a sleep disorder characterized by constant daytime fatigue and sleepiness, with a disturbance in nighttime REM sleep (the period of sleep when dreams occur). During the day or other periods of time when they would normaly be awake, people with narcolepsy often experience sudden episodes of REM sleep. They may also suffer from sleep paralysis and/or cataplexy, an abmpt, total loss of muscle control. Central nervous system stimulants like dextroamphetamine help to relieve these symptoms. 

Methylphenidate is considered a mild central nervous system stimulant that affects the brain and nerves, relieving fatigue, and inducing clearer thoughts for relatively short periods. According to the DEA, possible effects experienced by those who do not have ADHD or narcolepsy include increased alertness, excitation, and euphoria. Increased energy and increased mental clarity may be experienced for a short period. 

Baker TL, Guilleminault C, Nino-Murcia G, Dement WC. Comparative polysomno-graphic study of narcolepsy and idiopathic central nervous system hypersomnia. Sleep 1986 9 232-242. 

Amphetamines and similar central nervous system stimulants have been available for many years, but the substantial abuse liability and potential cardiovascular adverse effects have largely limited their use to the treatment of narcolepsy and attention-deficit-hyperactivity disorder. There has also been some utilization of amphetamines to combat sleepiness during military operations. 

Malik S, Boeve BF, Krahn LE, Silber MH (2001) Narcolepsy associated with other central nervous system disorders. Neurology 57 539-541... 

This is a central nervous system depressant licensed for the treatment of narcolepsy with cataplexy. At recommended doses, it has been associated with confusion, depression and other neuropsychiatric effects. Sodium oxybate is related to gamma hydroxybutyrate, a known drug of abuse, which has been associated with seizures, respiratory depression, coma and death. 

Methylphenidate (MPH, Ritalin ) is a central nervous system stimulant that is used for the treatment of attention deficit disorders, with and without hyperactivity, and narcolepsy. MPH has two chiral centres and is marketed as a racemic mixture. It is known that d-threo-MP is pharmacologically more active than l-threo-MPH. The drag is rapidly metabohzed in humans to the inactive ritalinic acid. High-throughput analysis with chiral selectivity is demanded for the bioanalysis of MPH and its major metabolite. 

Amphetamine (3) is orally active and, through an indirect mechanism, causes a general activation of the adrenergic nervous system. Unlike (l)and (2), amphetamine readily crosses the blood-brain barrier to activate a number of adrenergic pathways in the central nervous system (CNS). Amphetamine s CNS activity is the basis of its clinical utility in treating attention-deficit disorder, narcolepsy, and use as an anorexiant. These therapeutic areas are treated elsewhere in this volume. 

Medication is given to stimulate the central nervous system in order to induce a therapeutic response. These include medications that treat narcolepsy, attention deficit disorder (ADD), obesity, and reversal of respiratory distress. 

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