Recent studies provide valid criteria that help differentiate idiopathic
narcolepsy from other disorders of excessive
daytime somnolence [3]. Research to date suggests that idiopathic
narcolepsy might properly be considered a disorder of excessive
sleepiness with dysfunctional REM-sleep mechanisms, clinically evidenced as
cataplexy and electrophysiologically recognized as SOREMPs. Given these criteria, a diagnosis can generally be made using a combination of history, PSG, and MSLT. Traditionally, the medical treatment of idiopathic
narcolepsy has centered on a two-
drug regimen (stimulants for
sleepiness and TCAs for
cataplexy and auxiliary symptoms). Some newer medications are proving efficacious for
sleepiness with minimal adverse effects, whereas others may provide a single-
drug regimen that simultaneously addresses
sleepiness and
cataplexy [18]. New research has allowed some experts to hypothesize that idiopathic
narcolepsy may be the result of a
genetic predisposition to
autoimmune disease [176]. It is possible that aberrant genetic coding of elements in the
hypocretin/
orexin systems allows a sensitivity to inducible and possibly virally mediated changes, which leave cells in the lateral hypothalamus susceptible to autoimmune attack [96]. As such, genetic screening of high-risk individuals might eventually rationalize the prophylactic use of
immunosuppressants in some instances. In the future, for atypical cases(poorly responsive to therapy), genetic, CSF, and brain imaging studies, and possibly even neuronal
transplantation may prove beneficial in the assessment and treatment of idiopathic
narcolepsy.