Monitoring
Patients are followed up every 6 to 12 months to re-evaluate the social support network, monitor symptoms, and assess medication-related adverse effects (e.g., headaches, hypertension, rashes, etc) and efficacy.[83] A history and physical exam is performed in the first month of therapy and afterward 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 apnea, rapid eye movement sleep behavior disorder, and periodic limb movement disorder of sleep. It is recommended that development of tolerance to medications such as amphetamines 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.
Use of this content is subject to our disclaimer