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Primary Hypersomnias of Central Origin

Malhotra, Samit MD; Kushida, Clete A. MD, PhD, RPSGT

CONTINUUM: Lifelong Learning in Neurology: February 2013 - Volume 19 - Issue 1, Sleep Disorders - p 67–85
doi: 10.1212/01.CON.0000427212.05930.c4
Review Articles

Purpose of Review: This review discusses the various causes of primary hypersomnias with emphasis on clinical recognition, diagnosis, and treatment options.

Recent Findings: Narcolepsy is probably the most fascinating syndrome causing excessive daytime sleepiness. With increasing understanding of the hypocretin/orexin pathways and the neurotransmitters that subserve the role of wakefulness and sleep, newer therapeutic modalities with promising results are being investigated and opening new frontiers in the treatment of this rare but devastating disease.

Summary: This article reviews the primary hypersomnias of central origin. Where possible, clinical cases that highlight and explain the clinical syndromes are included. Treatment modalities and future directions are also discussed to help the clinician identify and treat the underlying disorder.

Supplemental Digital Content is available in the text.

Address correspondence to Dr Clete A. Kushida, Stanford University Center for Human Sleep Research, 780 Welch Rd, Suite 203, Palo Alto, CA 94304,

Relationship Disclosure: Dr Kushida has consulted for Apnex Medical, Inc, and Seven Dreamers Laboratories and has received royalties from Philips Respironics. Dr Kushida has received research support from Apnex Medical, Inc; GlaxoSmithKline; Impax Laboratories, Inc; Merck & Co, Inc; Pacific Medico Co, Ltd; ResMed; and XenoPort, Inc. Dr Malhotra reports no disclosure.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Kushida discusses the unlabeled use of selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, and tricyclic antidepressants for the treatment of narcolepsy with cataplexy; melatonin for the treatment of idiopathic hypersomnia; and amantadine, lithium, lamotrigine, valproic acid, and modafinil for the treatment of Kleine-Levin syndrome. Dr Malhotra reports no disclosure.

Supplemental digital content: Videos accompanying this article are cited in the text as Supplemental Digital Content. Videos may be accessed by clicking on links provided in the HTML, PDF, and iPad versions of this article; the URLs are provided in the print version. Video legends begin on page 83.

© 2013 American Academy of Neurology
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