18 In patients at sickness onset, the intravenous administration of immunoglobulins, at a high dose of 1 g/kg/day for 2 days, repeated three times at 4-week intervals, has been shown to decrease the frequency and severity of cataplexy for several months.19 The selleck authors suggest that such a treatment may change the course of the sickness at a time when the autoimmune process targeting the cataplexy networks can still be reversed. Common-sense behavior counseling may prove to be useful as a complement to pharmacotherapy. Maintenance of regular sleep schedules to enhance nighttime sleep quality and short daytime naps are indicated. Patients Inhibitors,research,lifescience,medical are advised to avoid

drinking alcohol and caffeine-containing beverages before bedtime. The treatment regimen can be modified as symptoms change. Symptoms may get worse, especially over the two to three decades following their first occurrence, but they may improve in older patients. Idiopathic Inhibitors,research,lifescience,medical hypersomnia Idiopathic hypersomnia is a rare condition and is 10 times less frequent than narcolepsy, although no prevalence study has ever been conducted.20 For a long time, it was confused with narcolepsy, but it was clearly individualized through polysomnographic studies.21,22 The International Classification of Sleep Disorders (ICSD)8 defines idiopathic hypersomnia

as a normal or prolonged nocturnal Inhibitors,research,lifescience,medical sleep episode that is associated with excessive daytime sleepiness consisting of prolonged (1- to 2-h) sleep episodes of non-REM sleep. Roth et al21 described two clinical forms: a monosymptomatic excessive daytime sleepiness and a polysymptomatic excessive daytime sleepiness associated with Inhibitors,research,lifescience,medical abnormally long nocturnal sleep and “sleep drunkenness” upon awakening. These forms are now described as idiopathic hypersomnia without a long sleep time and idiopathic hypersomnia with a long sleep time, respectively. Contrary to narcolepsy, diurnal sleep bouts are not irrepressible and do not Inhibitors,research,lifescience,medical restore normal vigilance, and nocturnal sleep

remains undisturbed, except for a delayed morning awakening. The condition often starts before 30 years of age. Familial occurrences are frequent. It is a life-long disorder that has severe social and professional impact.23 The diagnosis of idiopathic hypersomnia is often overestimated and requires not a thorough examination. It is appropriate in patients with excessive daytime sleepiness and/or sleep drunkenness, without any narcolepsy, periodic limb movements, or sleep apnea syndrome. Nocturnal polysomnography, to eliminate the latter conditions, is followed by MSLT sessions, which reveal short sleep latencies below 8 to 10 min, with less than two SOREMPs. However, the MSLT procedure requires that the patient be woken up early. To obtain evidence of abnormally long sleeping hours, 24-h to 48-h polysomnographic recordings may be necessary.