Monitoring
Patients are followed up every 6 to 12 months to re-evaluate the social support network, monitor symptoms, and assess medicine-related adverse effects (e.g., headaches, hypertension, rashes, etc) and efficacy.[83] A history and physical examination is performed in the first month of therapy and afterwards as needed to monitor symptoms and adverse effects of treatment. Response of excessive daytime sleepiness to therapy can be assessed by monitoring sleep latency on repeat multiple sleep latency test (MSLT) or maintenance of wakefulness test (MWT).[82][123]
Residual sleepiness on treatment is monitored using the Epworth Sleepiness Scale, repeat polysomnography, and/or MSLT or MWT. It is important to distinguish residual sleepiness due to treatment failure from the symptoms generated by comorbid conditions such as insomnia, obstructive sleep apnoea, rapid eye movement sleep behaviour disorder, and periodic limb movement disorder of sleep. It is recommended that development of tolerance to medicines such as amfetamines be evaluated regularly.[83] The MWT is also used to follow up those at risk (people who become drowsy on driving or who have impaired work performance) because it simulates real-life propensity to fall asleep. However, the results of the MWT overlap significantly with those for people without narcolepsy, and validated monitoring values are not yet available. Consequently, it is recommended that clinical assessment be used in conjunction with the MWT to assess impairment or risk for accidents.
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