Objective: We aimed to analyze the effect of Sodium Oxybate (SO) on motor events occurring during nighttime in children affected with Narcolepsy type 1 (NT1).

Background: NT1 has been reported to have peculiar clinical features in children. The occurrence of a severe and peculiar motor disorder during REM sleep in pediatric NT1 has been pointed out (Antelmi et al, 2017). SO is used as an off-label treatment in children with NT1, being effective at controlling excessive sleepiness, cataplexy, and disturbed night sleep.

Methods: Twenty children with NT1 were followed up after the at least three months of stable treatment with SO. All patients repeated video-PSG and the recordings were then reviewed by two independent experts in the field in order to analyze motor events. These latter were classified has previously reported (Antelmi et l, 2017) in elementary movements, if brief and non-purposeful and complex behaviors, if simulating purposeful behaviors. Baseline and follow-up data were confronted.

Results: Compared to baseline evaluation, NT1 patients taking SO showed a significant decrease of the pentad of NT1 symptoms. As long as motor nocturnal pattern is concerned, it emerged that elementary movements emerging from NREM sleep were significantly increased after the start of treatment while complex behaviors significantly decreased. The decrease of motor events during REM sleep was supported by a significantly increase of the values of the atonia index.

Conclusions: NT1 children has a complex movement disorder at nighttime during REM sleep, which responded to treatment with SO. The concordant increase in REM atonia index leads to infer on a direct role of the drug in modulating motor control during REM sleep.

References: Antelmi et al. Brain. 2017;140(6):1669-1679.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/rem-sleep-related-episodes-in-children-with-narcolepsy-type-1-after-treatment-with-sodium-oxybate/