SummaryEight pairs of subjects (each consisting of a narcoleptic and a control matched on the basis of age, sex, educational background and job) were evaluated under the following double-blind, randomized treatment conditions: baseline, placebo, low dose and high dose methamphetamine. Subjects were drug-free for 2 weeks prior to beginning the protocol. Methamphetamine was the only drug taken during the protocol and was given in a single morning dose of 0, 20 or 40-60 mg to narcoleptics and 0, 5 or 10 mg to controls. The protocol was 28 days long, with each of the four treatment conditions lasting 4 days followed by 3 days of washout. Nighttime polysomnography and daytime testing were done during the last 24 hours of each treatment condition. Daytime sleep tendency was assessed with the multiple sleep latency test (MSLT). Daytime performance was assessed with performance tests including a simple, computer-based driving task. Narcoleptics' mean MSLT sleep latency increased from 4.3 minutes on placebo to 9.3 minutes on high dose, compared with an increase from 10.4 to 17.1 minutes for controls. Narcoleptics' error rate on the driving task decreased from 2.53% on placebo to 0.33% on high dose, compared with a decrease from 0.22% to 0.16% for controls. The effects of methamphetamine on nocturnal sleep were generally dose-dependent and affected sleep continuity and rapid eye movement (REM) sleep. Elimination half life was estimated to be between 15.9 and 22.0 hours. Mild side effects emerged in a dose-dependent fashion and most often involved the central nervous system and gastrointestinal tract. We concluded that methamphetamine caused a dose-dependent decrease in daytime sleep tendency and improvement in performance in both narcoleptics and controls. Methamphetamine at doses of 40-60 mg allowed narcoleptics to function at levels comparable to those of unmedicated controls.
KeywordsNarcolepsy; CNS stimulants; Methamphetamine; MSLT; Polysomnography; Driving task Narcolepsy is a neurological disorder affecting some 250,000-350,000 individuals in the United States, a prevalence rate similar to that for multiple sclerosis (1-4). Narcolepsy is thought to stem from genetic or early developmental abnormalities in catecholamine regulation within the brain (5,6). The disorder is characterized by a pentad of symptoms: daytime somnolence, cataplexy, hypnagogic hallucinations, sleep paralysis and disturbed nocturnal sleep (7,8). The etiology of daytime somnolence in narcolepsy is poorly understood, but seems to stem from dysregulation of the sleep/wake cycle, rather than from an excessive need for sleep (9,10). Hypnagogic hallucinations, sleep paralysis and cataplexy are manifestations of an underlying dysfunction in the control and organization of rapid eye movement (REM) sleep (7). Pathological somnolence is by far the most disabling and potentially dangerous symptom of narcolepsy. Pathological somnolence, whether from narcolepsy or from other causes such Note: This article was planned for the April issue, which included artic...