John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
The discovery that a lack of hypocretins in the cerebrospinal fluid (CSF) may be related to the cause of narcolepsy could lead to the development of tests to determine the level of hypocretins in the CSF. Such tests could help in the diagnosis of narcolepsy. The expectation is that these tests will be simple (drawing blood), and will reflect the level of hypocretins in the CSF. In addition, the discovery of the role of hypocretins in the development of narcolepsy may lead to the development of new drugs for the treatment of narcolepsy.
Narcolepsy At A Glance
Narcolepsy is a chronic disease of the central nervous system.
The symptoms include excessive daytime sleepiness (EDS), loss of muscle tone
(cataplexy), distorted perceptions (hypnagogic hallucinations), inability to
move or talk (sleep paralysis), disturbed nocturnal sleep, and automatic
Narcolepsy usually begins in teenagers or young adults and affects both
The prevalence of narcolepsy is similar to that of Parkinson's
disease and multiple sclerosis. Approximately 125,000 to 200,000 Americans are
estimated to suffer from narcolepsy, but only fewer than 50,000 are actually
Abnormalities in the structure and function of a particular group of nerve
cells in the brain called hypocretin neurons are thought to play a role in the
development of narcolepsy.
The diagnosis of narcolepsy is based on a clinical evaluation, specific
questionnaires, sleep logs or diaries, and the results of sleep laboratory tests
(polysomnography and multiple sleep latency test).
Treatment options for narcolepsy include drug and behavioral modification
therapies and disease-specific education of the patient and family members. The
treatment should be individualized, depending on the types and severity of the
symptoms, the life conditions of the patients, and the specific goals of
Optimal management usually takes weeks to months to achieve and requires
continued communication among the physician, patient, family
members, and others.
Alerting medications are used for the treatment of excessive daytime
sleepiness. Amphetamines and
methylphenidate (Ritalin) are general CNS stimulants that decrease sleepiness
and improve alertness. Modafinil (Provigil) has alerting effects similar to
those of the traditional stimulants but has less undesirable side effects.
Anticataplectic medications are used to treat cataplexy, hypnagogic
hallucinations, and sleep paralysis. Tricyclic antidepressants (TCAs) are often
effective in controlling cataplexy, but also frequently produce side effects
that could limit their use.
Selective serotonin reuptake inhibitors (SSRIs) are also useful in the
treatment of cataplexy and their side effects are milder. Sodium oxybate (Xyrem)
is a medication with anticataplectic effects that also improves disturbed
Behavioral approaches to treating narcolepsy include establishing a structured sleep-wake cycle and planned naps, and involve diet, exercise, and occupational, marriage, and family counseling.