Hiperglicinemia não cetótica: estudo de um caso

A hiperglicinemia não cetótica é erro inato do metabolismo que se manifesta por crises epilépticas de difícil controle desde os primeiros dias de vida, em recém-nascido hipotônico. A falta do enzima que catalisa a conversão de glicina em ácido hidroximetiltetra-hidrofólico, dióxido de carbono e amônia, no fígado e no cérebro, resulta em aumento da concentração de glicina no sangue. Neste estudo é relatado caso de hiperglicinemia diagnosticado no período neonatal e caracterizado por hipotonia e múltiplas convulsões não controláveis. Os achados clínicos e eletrencefalográficos, aspectos do tratamento e do estudo anátomo-patológico são comentados

Relative frequency, clinical, neuroimaging, and postsurgical features of pediatric temporal lobe epilepsy

We describe the relative frequency, clinical features, neuroimaging and pathological results, and outcome after pharmacological or surgical intervention for a series of pediatric patients with temporal lobe epilepsy (TLE) from an epilepsy center in Brazil. The medical records of children younger than 12 years with features strongly suggestive of TLE were reviewed from January 1999 to June 1999. Selected children were evaluated regarding clinical, EEG, and magnetic resonance imaging (MRI) investigation and divided into three groups according to MRI: group 1 (G1, N = 9), patients with hippocampal atrophy; group 2 (G2, N = 10), patients with normal MRI, and group 3 (G3, N = 12), patients with other specific temporal lesions. A review of 1732 records of children with epilepsy revealed 31 cases with TLE (relative frequency of 1.79%). However, when the investigation was narrowed to cases with intractable seizures that needed video-EEG monitoring (N = 68) or epilepsy surgery (N = 32), the relative frequency of TLE increased to 19.11 (13/68) and 31.25% (10/32), respectively. At the beginning of the study, 25 of 31 patients had a high seizure frequency (80.6%), which declined to 11 of 31 (35.5%) at the conclusion of the study, as a consequence of pharmacological and/or surgical therapy. This improvement in seizure control was significant in G1 (P < 0.05) and G3 (P < 0.01) mainly due to good postsurgical outcome, and was not significant in G2 (P > 0.1, McNemar's test). These results indicate that the relative frequency of TLE in children was low, but increased considerably among cases with pharmacoresistant seizures. Patients with specific lesions were likely to undergo surgery, with good postoperative outcomes

Brazilian Guidelines For The Diagnosis Of Narcolepsy [diretrizes Brasileiras Para O Diagnóstico Da Narcolepsia]

This manuscript contains the conclusion of the consensus meeting on the diagnosis of narcolepsy based on the review of Medline publications between 1980-2010. Narcolepsy is a chronic disorder with age at onset between the first and second decade of life. Essential narcolepsy symptoms are cataplexy and excessive sleepiness. Cataplexy is defined as sudden, recurrent and reversible attacks of muscle weakness triggered by emotions. Accessory narcolepsy symptoms are hypnagogic hallucinations, sleep paralysis and nocturnal fragmented sleep. The clinical diagnosis according to the International Classification of Sleep Disorders is the presence of excessive sleepiness and cataplexy. A full in-lab polysomnography followed by a multiple sleep latency test is recommended for the confirmation of the diagnosis and co-morbidities. The presence of two sleep-onset REM period naps in the multiple sleep latency test is diagnostic for cataplexy-free narcolepsy. A positive HLA-DQB1*0602 with lower than 110pg/mL level of hypocretin-1 in the cerebrospinal fluid is required for the final diagnosis of cataplexy- and sleep-onset REM period-free narcolepsy.323294304(2005) International Classification of Sleep Disorders, Second Edition: Diagnostic and Coding Manual, , American Academy of Sleep Medicine. Westchester, IL: American Academy of Sleep MedicineLongstreth Jr., W.T., Ton, T.G., Koepsell, T., Gersuk, V.H., Hendrickson, A., Velde, S., Prevalence of narcolepsy in King County, Washington, USA (2009) Sleep Med, 10 (4), pp. 422-426Longstreth Jr., W.T., Koepsell, T.D., Ton, T.G., Hendrickson, A.F., Van Belle, G., The epidemiology of narcolepsy (2007) Sleep, 30 (1), pp. 13-26Silber, M.H., Krahn, L.E., Olson, E.J., Pankratz, V.S., The epidemiology of narcolepsy in Olmsted County, Minnesota: A population-based study (2002) Sleep, 25 (2), pp. 197-202Hublin, C., Kaprio, J., Partinen, M., Koskenvuo, M., Heikkila, K., Koskimies, S., Guillemmault, C., The prevalence of narcolepsy: An epidemiological study of the Finnish twin cohort (1994) Annals of Neurology, 35 (6), pp. 709-716. , DOI 10.1002/ana.410350612Wing, Y.K., Li, R.H., Lam, C.W., Ho, C.K., Fong, S.Y., Leung, T., The prevalence of narcolepsy among Chinese in Hong Kong (2002) Ann Neurol, 51 (5), pp. 578-584Mignot, E., Genetic and familial aspects of narcolepsy (1998) Neurology, 50 (2 SUPPL. 1), pp. S16-22Mignot, E., Lin, L., Rogers, W., Honda, Y., Qiu, X., Lin, X., Okun, M., Risch, N., Complex HLA-DR and -DQ interactions confer risk of narcolepsycataplexy in three ethnic groups (2001) Am J Hum Genet, 68 (3), pp. 686-699Pelin, Z., Guilleminault, C., Risch, N., Grumet, F.C., Mignot, E., HLA-DQB1*0602 homozygosity increases relative risk for narcolepsy but not disease severity in two ethnic groups (1998) Tissue Antigens, 51 (1), pp. 96-100. , US Modafinil in Narcolepsy Multicenter Study GroupMignot, E., Kimura, A., Latlermann, A., Lin, X., Yasunaga, S., Mueller-Eckhardt, G., Rattazzi, C., Underbill, P., Extensive HLA class II studies in 58 non-DRB 1*15 (DR2) narcoleptic patients with cataplexy (1997) Tissue Antigens, 49 (4), pp. 329-341Ellis, M.C., Hetisimer, A.H., Ruddy, D.A., Hansen, S.L., Kronmal, G.S., McClelland, E., Quintana, L., Mignot, E., HLA class II haplotype and sequence analysis support a role for DQ in narcolepsy (1997) Immunogenetics, 46 (5), pp. 410-417Mignot, E., Lin, X., Arrigoni, J., Macaubas, C., Olive, F., Hallmayer, J., Underhill, P., Grumet, F.C., DQB1*0602 and DQA1*0102 (DQ1) are better markers than DR2 for narcolepsy in Caucasian and black Americans (1994) Sleep, 17 (8 SUPPL.), pp. S60-7Mignot, E., Hayduk, R., Black, J., Grumet, F.C., Guilleminault, C., HLA DQB1*0602 is associated with cataplexy in 509 narcoleptic patients (1997) Sleep, 20 (11), pp. 1012-1020Morgun, A., Gonçalves-Primo, A., Shulzhenko, N., Rampim, G.F., Mine, K.L., Gerbase-DeLima, M., HLA-DQB1 and -DRB1 Alleles, Cytokine Polymorphismis and KIR Gene Frequencies in a Population (Caucasian) from South East Brazil (2004) Hum Immunol, 65 (9), pp. 879-882Temin, J., Marques, G.D., Morgun, A., Shulzhenko, N., Rampim, G.F., Gerbase-de Lima, M., HLA-DQB1 and -DRB1 Alleles and Cytokine Polymorphismis in a Mulatto population from South East Brazil (2004) Hum Immunol, 65 (9), pp. 882-886Miyagawa, T., Honda, M., Kawashima, M., Shimada, M., Tanaka, S., Honda, Y., Tokunaga, K., Polymorphism located in TCRA locus confers susceptibility to essential hypersomnia with HLA-DRB1*1501-DQB1*0602 haplotype (2010) J Hum Genet, 55 (1), pp. 63-65Hallmayer, J., Faraco, J., Lin, L., Hesselson, S., Winkelmann, J., Kawashima, M., Mayer, G., Mignot, E., Narcolepsy is strongly associated with the T-cell receptor alpha locus (2009) Nat Genet, 41 (6), pp. 708-711Dauvilliers, Y., Neidhart, E., Lecendreux, M., Billiard, M., Tafti, M., MAO-A and COMT polymorphisms and gene effects in narcolepsy (2001) Molecular Psychiatry, 6 (4), pp. 367-372. , DOI 10.1038/sj.mp.4000911Dauvilliers, Y., Neidhart, E., Billiard, M., Tafti, M., Sexual dimorphism of the catechol-O-methyltransferase gene in narcolepsy is associated with response to modafinil (2002) Pharmacogenomics Journal, 2 (1), pp. 65-68. , DOI 10.1038/sj.tpj.6500088Dauvilliers, Y., Arnulf, I., Narcolepsie avec cataplexie (2008) Revue Neurologique, 164 (8-9), pp. 634-645Dauvilliers, Y., Arnulf, I., Mignot, E., Narcolepy with cataplexy (2007) Lancet, 369 (9560), pp. 499-511Nishino, S., Clinical and neurobiological aspects of narcolepsy (2007) Sleep Med, 8 (4), pp. 373-399Nishino, S., Narcolepsy (2006) Sleep Med Clin, 1, pp. 47-61Dauvilliers, Y., Billiard, M., Montplaisir, J., Clinical aspects and pathophysiology of narcolepsy (2003) Clin Neurophysiol, 114 (11), pp. 2000-2017Thannickal, T.C., Nienhuis, R., Siegel, J.M., Localized loss of hypocretin (orexin) cells in narcolepsy without cataplexy (2009) Sleep, 32 (8), pp. 993-998Overeem, S., Black III, J.L., Lammers, G.J., Narcolepsy: Immunological aspects (2008) Sleep Med Rev, 12 (2), pp. 95-107Boehmer, L.N., Wu, M.-F., John, J., Siegel, J.M., Treatment with immunosuppressive and anti-inflammatory agents delays onset of canine genetic narcolepsy and reduces symptom severity (2004) Experimental Neurology, 188 (2), pp. 292-299. , DOI 10.1016/j.expneurol.2004.04.006, PII S0014488604001396Vignatelli, L., D'Alessandro, R., Mosconi, P., Ferini-Strambi, L., Guidolin, L., De Vincentiis, A., Plazzi, G., Health-related quality of life in Italian patients with narcolepsy: The SF-36 health survey (2004) Sleep Med, 5 (5), pp. 467-475. , GINSEN (Gruppo Italiano Narcolessia-Studio Epidemiologico Nazionale)Rieger, M., Mayer, G., Gauggel, S., Attention deficits in patients with narcolepsy (2003) Sleep, 26 (1), pp. 36-43Bayon, V., Damien Léger, D., Philip, P., Socio-professional handicap and accidental risk in patients with hypersomnias of central origin (2009) Sleep Med, 13 (6), pp. 421-426Aldrich, M.S., Automobile accidents in patient with sleep disorders (1989) Sleep, 12 (6), pp. 487-494Fortuyn, H.A., Lappenschaar, M.A., Furer, J.W., Hodiamont, P.P., Rijnders, C.A., Renier, W.O., Buitelaar, J.K., Overeem, S., Anxiety and mood disorders in narcolepsy: A case-control study (2010) Gen Hosp Psychiatry, 32 (1), pp. 49-56Bonakis, A., Howard, R.S., Williams, A., Bonakis, A., Howard, R.S., Williams, A., Narcolepsy presenting as REM sleep behaviour disorder (2008) Clinical Neurol Neurosurg, 110 (5), pp. 518-520Dauvilliers, Y., Rompre, S., Gagnon, J.-F., Vendette, M., Petit, D., Montplaisir, J., REM sleep characteristics in narcolepsy and REM sleep behavior disorder (2007) Sleep, 30 (7), pp. 844-849Mattarozzi, K., Bellucci, C., Campi, C., Cipolli, C., Ferri, R., Franceschini, C., Mazzetti, M., Plazzi, G., Clinical, behavioural and polysomnographic correlates of cataplexy in patients with narcolepsy/cataplexy (2008) Sleep Med, 9 (4), pp. 425-433Nevsimalova, S., Prihodova, I., Kemlink, D., Linm, L., Mignot, E., REM behavior disorder (RBD) can be one of the first symptoms of childhood narcolepsy (2007) Sleep Med, 8 (7-8), pp. 784-786Nightingale, S., Orgill, J.C., Ebrahim, I.O., De Lacy, S.F., Agrawal, S., Williams, A.J., The association between narcolepsy and REM behavior disorder (RBD) (2005) Sleep Med, 6 (3), pp. 253-258Fortuyn, H.A., Swinkels, S., Buitelaar, J., Renier, W.O., Furer, J.W., Rijnders, C.A., Hodiamont, P.P., Overeem, S., High prevalence of eating disorders in narcolepsy with cataplexy: A case-control study (2008) Sleep, 31 (3), pp. 335-341Dahmen, N., Bierbrauer, J., Kasten, M., Increased prevalence of obesity in narcoleptic patients and relatives (2001) Eur Arch Psychiatry Clin Neurosci, 251 (2), pp. 85-89Chabas, D., Foulon, C., Gonzalez, J., Nasr, M., Lyon-Caen, O., Willer, J.C., Derenne, J.P., Arnulf, I., Eating disorder and metabolism in narcoleptic patients (2007) Sleep, 30 (10), pp. 1267-1273Kotagal, S., Krahn, L.E., Slocumb, N., A putative link between childhood narcolepsy and obesity (2004) Sleep Med, 5 (2), pp. 147-150Sansa, G., Iranzo, A., Santamaria, J., Obstructive sleep apnea in narcolepsy (2010) J Sleep Med, 11 (1), pp. 93-95Dahmen, N., Kasten, M., Wieczorek, S., Gencik, M., Epplen, J.T., Ullrich B, B., Increased frequency of migraine in narcoleptic patients: A confirmatory study (2003) Cephalalgia, 23 (1), pp. 14-19Dahmen, N., Querings, K., Grun, B., Bierbrauer, J., Increased frequency of migraine in narcoleptic patients (1999) Neurology, 52 (6), pp. 1291-1293Nishino, S., Kanbayashi, T., Symptomatic narcolepsy, cataplexy and hypersomnia, and their implications in the hypothalamic hypocretin/orexin system (2005) Sleep Med Rev, 9 (4), pp. 269-310Billiard, M., Diagnosis of narcolepsy and idiopathic hypersomnia. An update based on the International Classification of Sleep Disorders (2007) Sleep Med Rev, 11 (5), pp. 377-388Sasai, T., Inoue, Y., Komada, Y., Sugiura, T., Matsushima, E., Comparison of clinical characteristics among narcolepsy with and without cataplexy and idiopathic hypersomnia without long sleep time, focusing on HLA-DRB1*1501/DQB1*0602 finding (2009) Sleep Med, 10 (9), pp. 961-966Arnulf, I., Zeitzer, J.M., File, J., Farber, N., Mignot, E., Kleine-Levin syndrome: A systematic review of 186 cases in the literature (2005) Brain, 128 (PART 12), pp. 2763-2776Doose, H., Myoclonic-astatic epilepsy in early childhood (1992) Epileptic Syndromes in Infancy, Childhood and Adolescence, pp. 103-114. , Roger J, Bureau M, Dravet C, editors. 2 ed. London: John LibbeyZeman, A., Douglas, N., Aylward, R., Narcolepsy mistaken for epilepsy (2001) BMJ, 322 (7280), pp. 216-218Zeman, A., Britton, T., Neil Douglas, D., Hansen, A., Hicks, J., Robin, H., Narcolepsy and excessive daytime sleepiness (2004) BMJ, 329 (7468), pp. 724-728Baumann, C.R., Bassetti, C.L., Valko, P.O., Haybaeck, J., Morten Keller, M., Clark, E., Stocker, R., Scammell, T.E., Loss of hypocretin (Orexin) neurons with traumatic brain injury (2009) Ann Neurol, 66 (4), pp. 555-559Droogleever-Fortuyn, H.A., Psychotic symptoms in narcolepsy: Phenomenology and a comparison with schizophrenia (2009) Gen Hospital Psychiatr, 31, pp. 146-154Ohayon, M.M., Priest, R.G., Caulet, M., Guilleminault, C., Hypnagogic and hypnopompic hallucinations: Pathologic phenomenon? (1996) Br J Psychiatry, 169 (4), pp. 459-467Ohayon, M.M., Zulley, J., Guilleminault, C., Smirne, S., Prevalence and pathologic association of sleep paralysis in the general population (1999) Neurology, 52 (6), pp. 1194-1200D'Cruz, O., Vaughn, B., Gold, S., Symptomatic cataplexy in pontomedullary lesions (1994) Neurology, 44 (11), pp. 2189-2191Iber, C., Ancoli-Israel, S., Chesson, A.L., Quan, S.F., (2007) The AASM Manual for the Scoring of Sleep and Associated Events: Rules, Terminology, and Technical Specifications, , Westchester, Illinois: American Academy of Sleep MedicineKushida, C.A., Littner, M.R., Morgenthaler, T., Alessi, C.A., Bailey, D., Coleman Jr., J., Friedman, L., Wise, M., The indications for polysomnography and related proce dures (2005) Sleep, 28 (4), pp. 499-521Practice parameters for clinical use of the multiple sleep latency test and the maintenance of wakefulness test (2005) Sleep, 28, pp. 113-121. , Standards of Practice Committee of the American Academy of Sleep MedicineBroughton, R., Dunham, W., Newman, J., Lutley, K., Duschesne, P., Rivers, M., Ambulatory 24 hour sleep-wake monitoring in narcolepsy -cataplexy compared with matched control subjects (1988) Electroencephalogr Clin Neurophysiol, 70 (6), pp. 473-481Montplaisir, J., Billiard, M., Takahashi, S., Bell, I.R., Guilleminault, C., Dement, W.C., Twenty-four-hour recording in REM-narcoleptics with special reference to nocturnal sleep disruption (1978) Biol Psychiatry, 13 (1), pp. 73-89Montplaisir, J., Godbout, R., Nocturnal sleep of narcoleptic patients: Revisited (1986) Sleep, 9 (1 PART 2), pp. 159-161Vankova, J., Nevsimalova, S., Sonka, K., Spackova, N., Svejdova-Blazejova, K., Increased REM density in narcolepsy-cataplexy and the polysymptomatic form of idiopathic hypersomnia (2001) Sleep, 24 (6), pp. 707-711Dauvilliers, Y., Pennestri, M.H., Petit, D., Dhang-Vu, T., Lavigne, G., Montplaisir, J., Periodic leg movements during sleep and wakefulness in Narcolepsy J (2007) Sleep Res, 16 (3), pp. 333-339Arand, D., Bonnet, M., Hurwitz, T., Mitler, M., Rosa, R., Sangel, B., The Clinical Use of the MSLT and MWT (2005) Sleep, 28 (1), pp. 123-144Bonnet, M.H., ACNS clinical controversy: MSLT and MWT have limited clinical utility (2006) J Clin Neurophysiol, 23 (1), pp. 50-58Wise, M.S., Objective Measures of Sleepiness and Wakefulness: Application to the Real World? (2006) J Clin Neurophysiol, 23 (1), pp. 39-49Mitler, M.M., Gujavarty, K.S., Browman, C.P., Maintenance of wake fulness test: A polysomnographic technique for evaluation treat ment efficacy in patients with excessive somnolence (1982) Electroen Cephalogr Clin Neurophysiol, 53 (6), pp. 658-661Doghramji, K., Mitler, M., Sangal, B., Shapiro, Taylor, S., Shapiro, C., Taylor, S., Youakim, J.M., A normative study of the maintenance of wakefulness test (MWT) (1997) Electroencephalogr Clin Neurophysiol, 103 (5), pp. 554-562Johns, M.W., A new method for measuring daytime sleepiness: The Epworth sleepiness scale (1991) Sleep, 14 (6), pp. 540-545Johns, M.W., Sleepiness in different situations measured by the Epworth sleepiness scale (1994) Sleep, 17 (8), pp. 703-710Johns, M.W., Sensitivity and specificity of the multiple sleep latency test (MSLT), the maintenance of wakefulness test and the Epworth sleepiness scale: Failure of the MSLT as a gold standard (2000) J Sleep Res, 9 (1), pp. 5-11Lin, L., Hungs, M., Mignot, E., Narcolepsy and the HLA region (2001) J Neuroimmunol, 117 (1-2), pp. 9-20Bougin, P., Zeitzer, J.M., Mignot, E., CSF hypocretin-1 assessment in sleep and neurological disorders (2008) Lancet Neurol, 7 (7), pp. 649-662De Lecea, L., Kilduff, T.S., Peyron, C., Gao, X., Foye, P.E., Danielson, P.E., Fukuhara, C., Sutcliffe, J.G., The hypocretins: Hypothalamus-specific peptides with neuroexcitatory activity (1998) Proc Natl Acad Sci USA, 95 (1), pp. 322-327Sakurai, T., Amemiya, A., Ishii, M., Matsuzaki, I., Chemelli, R.M., Tanaka, H., Williams, S.C., Yanagisawa, M., Orexins and orexin receptors: A family of hypothalamic neuropeptides and G protein-coupled receptors that regulate feeding behavior (1998) Cell, 92 (4), pp. 573-585Fronczek, R., Bauman, C.R., Lammers, G.J., Bassetti, C.L., Overeem, S., Hypocretin/orexin disturbances in neurological disorders (2009) Sleep Med Rev, 13 (1), pp. 9-22Shchenko, D., Murillo-Rodriguez, E., Lin, L., Xu, M., Hallett, L., Nishino, S., Lin, L., Shiromani, P.J., Relationship between CSF hypocretin levels and hypocretin neuronal loss (2003) Exp Neurol, 184 (2), pp. 1010-1016Mignot, E., Lammers, G.J., Ripley, B., Okun, M., Nevsimalova, S., Overeem, S., Overeem, S., Nishino, S., The role of cerebrospinal fluid hypocretin measurement in the diagnosis of narcolepsy and other hypersomnias (2002) Arch Neurol, 59 (10), pp. 1553-1562Dauvilliers, Y., Baumann, C.R., Carlander, B., Bischof, M., Blatter, T., Lecendreux, M., Maly, F., Bassetti, C.L., CSF hypocretin-1 levels in narcolepsy, Kleine-Levin syndrome, and other hypersomnias and neurological conditions (2003) J Neurol Neurosurg Psychiatry, 74 (12), pp. 1667-1673Baumann, C.R., Bassetti, C.L., Hypocretins (orexins) and sleep-wake disorders (2005) Lancet Neurol, 4 (10), pp. 673-68

Brazilian Guidelines For The Treatment Of Narcolepsy [diretrizes Brasileiras Para O Tratamento Da Narcolepsia]

This manuscript contains the conclusion of the consensus meeting of the Brazilian Sleep Association with Brazilian sleep specialists on the treatment of narcolepsy based on the review of medical literature from 1980 to 2010. The manuscript objectives were to reinforce the use of agents evaluated in randomized placebo-controlled trials and to issue consensus opinions on the use of other available medications as well as to inform about safety and adverse effects of these medications. Management of narcolepsy relies on several classes of drugs, namely, stimulants for excessive sleepiness, antidepressants for cataplexy and hypnotics for disturbed nocturnal sleep. Behavioral measures are likewise valuable and universally recommended. All therapeutic trials were analyzed according to their class of evidence. Recommendations concerning the treatment of each single symptom of narcolepsy as well as general recommendations were made. Modafinil is the first-line pharmacological treatment of excessive sleepiness. Second-line choices for the treatment of excessive sleepiness are slow-release metylphenidate followed by mazindol. The first-line treatments of cataplexy are the antidepressants, reboxetine, clomipramine, venlafaxine, desvenlafaxine or high doses of selective serotonin reuptake inibitors antidepressants. As for disturbed nocturnal sleep the best option is still hypnotics. Antidepressants and hypnotics are used to treat hypnagogic hallucinations and sleep paralysis.323305314Morgenthaler, T.I., Kapur, V.K., Brown, T., Swick, T.J., Alessi, C., Aurora, R.N., Boehlecke, B., Zak, R., Practice parameters for the treatment of narcolepsy and other hypersomnias of central origin (2007) Sleep, 30 (12), pp. 1705-1711. , Standards of Practice Committee of the American Academy of Sleep MedicineSackett, D.L., Rules of evidence and clinical recommendations for the management of patients (1993) Can J Cardiol, 9 (6), pp. 487-489Eddy, D., (1992) A Manual for Assessing Health Practices and Designing Practice Policies: The Explicit Approach, , Philadelphia: American College of PhysiciansLevels of Evidence, , http://www.cebm.net/index.aspx0=1025, Web Site. [cited 2009 dez 16]. Available fromDelbecq, A., Vande Ven, A., A group process model for prob lem identification and programme planning (1971) J Appl Behav Sci, 7, pp. 467-492Britton, T., Hansen, A., Hicks, J., Howard, R., Meredith, A., (2002) Guidelines on the Diagnosis and Management of Narcolepsy in Adults and Children. Evidence-Based Guidelines for the UK with Graded Recommendations, , Ashtead, UK: Taylor Patten Communications LtdGuilleminault, C., Fromherz, S., Narcolepsy: Diagnosis and management (2005) Principles and Practice of Sleep Medicine, , Kryger MH, Roth T, Dement WC, editors. 4th ed. Philadelphia: Saunders, ElsevierBilliard, M., Bassetti, C., Dauvilliers, Y., Dolenc-Groselj, L., Lammers, G.J., Mayer, G., Pollmacher, T., Sonka, K., EFNS guidelines on management of narcolepsy (2006) Eur J Neurol, 13 (10), pp. 1035-1048Wise, M.S., Arand, D.L., Auger, R.R., Brooks, S.N., Watson, N.F., Treatment of narcolepsy and other hypersomnias of central origin (2007) Sleep, 30 (12), pp. 1712-1727Roehrs, T., Zorick, F., Wittig, R., Paxton, C., Sicklesteel, J., Roth, T., Alerting effects of naps in patients with narcolepsy (1986) Sleep, 9, pp. 194-199Mullington, J., Broughton, R., Scheduled naps in the management of daytime sleepiness in narcolepsy- Cataplexy (1993) Sleep, 16 (5), pp. 444-456Rogers, A.E., Aldrich, M.S., Lin, X., A comparison of three different sleep schedules for reducing daytime sleepiness in narcolepsy (2001) Sleep, 24 (4), pp. 385-391Chen, W., Mignot, E., Narcolepsy and hypersomnia of central origin: Diagnosis, differential pearls, and management (2007) Review of Sleep Medicine, pp. 75-94. , Barkoukis T, Avidan A, editors. 2nd ed. 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