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CC BY-NC-ND 4.0 · Sleep Sci 2022; 15(S 01): 278-284
DOI: 10.5935/1984-0063.20220004
ORIGINAL ARTICLES

Impact of L-carnitine in narcolepsy treatment: a systematic review on the effectiveness and safety

Cristina Salles
1   Escola Bahiana de Medicina e Saúde Pública, International Center on Clinical Sleep Medicine and Research - Salvador - Bahia - Brazil.
,
Maria Clara Freitas
1   Escola Bahiana de Medicina e Saúde Pública, International Center on Clinical Sleep Medicine and Research - Salvador - Bahia - Brazil.
,
Miguel Meira e Cruz
1   Escola Bahiana de Medicina e Saúde Pública, International Center on Clinical Sleep Medicine and Research - Salvador - Bahia - Brazil.
2   Centro Cardiovascular da Universidade de Lisboa, Lisbon School of Medicine, Sleep Unit - Lisbon - Lisbon - Portugal.
3   Faculdade São Leopoldo Mandic, Neuroimune Pain Interface Lab - Campinas - São Paulo - Brazil.
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Introduction Studies have shown that narcolepsy patients may present with low serum acylcarnitine levels, demonstrating a dysfunctional beta fatty acid oxidation pathway in these patients.

Objective Evaluate the therapeutic efficacy of L-carnitine as a treatment for narcolepsy patients.

Methods This study runned in form of systematic review. The terms used for the search: (“narcolepsy”[MeSH Terms] OR “narcolepsy”[All Fields]) AND (“carnitine”[MeSH Terms] OR “carnitine”[All Fields] OR “l carnitine”[All Fields]). Were included all surveys published until January 2021, with the diagnosis of narcolepsy, that performed drug treatment with I-carnitine. The clinical endpoints of interest were: excessive daytime sleepiness, dissociative REM sleep manifestations: cataplexy, sleep paralysis, hypnagogic hallucinations, and early REM sleep (REM sleep naps, SOREMP).

Results L-carnitine was found to be well-tolerated and without side effects in all surveys, at dosages ranging from 500 to 510 mg/day. Newborns did not present complications during delivery.

Conclusion This study corroborates the efficacy and good tolerability of L-carnitine therapy as a treatment for patients with narcolepsy, including during pregnancy.

Acetylcarnitine - Narcolepsy - Pregnancy

FUNDING SOURCES

This survey is funded by CNPq, granting number: 126739/2020-0.




Publication History

Received: 14 April 2021

Accepted: 21 July 2021

Article published online:
01 December 2023

© 2023. Brazilian Sleep Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • REFERENCES

  • 1 Bassetti CLA, Kallweit U, Vignatelli L, Plazzi G, Lecendreux M, Baldin E, et al. European guideline and expert statements on the management of narcolepsy in adults and children. Eur J Neurol. 2021;(March):1.16.
  • 2 Serin Y, Acar Tek N. Effect of Circadian Rhythm on Metabolic Processes and the Regulation of Energy Balance. Ann Nutr Metab. 2019;74(4):322.30.
  • 3 Slowik JM, Collen JF, Yow AG, Army M, Reed W, Military N. Narcolepsy. 2021;
  • 4 American Academy of Sleep Medicine. International classification of sleep disorders, Third Edition. 2014;475.84.
  • 5 Ingravallo F, Gnucci V, Pizza F, Vignatelli L, Govi A, Dormi A, et al. The burden of narcolepsy with cataplexy: How disease history and clinical features influence socio-economic outcomes. Sleep Med [Internet]. 2012;13(10):1293.300. Available from: http://dx.doi.org/10.1016/j. sleep.2012.08.002
  • 6 Bassetti CLA, Adamantidis A, Burdakov D, Han F, Gay S, Kallweit U, et al. Narcolepsy . clinical spectrum, aetiopathophysiology, diagnosis and treatment. Nat Rev Neurol. 2019;15(9):519.39.
  • 7 Aloe F, Alves RC, Araujo JF, Azevedo A, Bacelar A, Bezerra M, et al. Brazilian guidelines for the treatment of narcolepsy. Rev Bras Psiquiatr. 2010;32(3):305.14.
  • 8 Franceschini C, Pizza F, Cavalli F, Plazzi G. A practical guide to the pharmacological and behavioral therapy of Narcolepsy. Neurotherapeutics [Internet]. 2021;18(1):6.19. Available from: https:// doi.org/10.1007/s13311-021-01051-4
  • 9 Barateau L, Dauvilliers Y. Recent advances in treatment for narcolepsy. Ther Adv Neurol Disord. 2019;12.
  • 10 Swick TJ. Treatment paradigms for cataplexy in narcolepsy: Past, present, and future. Nat Sci Sleep. 2015;7:159.69.
  • 11 Perrier L, Jurado D, Anfray C, Acquadro C. Pro Labeling in Products Approved by the European Medicines Agency (EMA) for Narcolepsy. Value Heal. 2017;20(9):A727.
  • 12 Barros F, Aguilar ACR, Tufik S, Coelho FM. Oral L-Carnitine used to treat narcoleptic type 1 patient during pregnancy-A case report. Sleep Sci. 2018;11(4):215.6.
  • 13 Miyagawa T, Miyadera H, Tanaka S, Kawashima M, Shimada M, Honda Y, et al. Abnormally low serum acylcarnitine levels in narcolepsy patients. Sleep. 2011;34(3).
  • 14 Miyagawa T, Kawamura H, Obuchi M, Ikesaki A, Ozaki A, Tokunaga K, et al. Effects of Oral L-Carnitine Administration in Narcolepsy Patients: A Randomized, Double-Blind, Cross-Over and Placebo-Controlled Trial. PLoS One. 2013;8(1):6.11.
  • 15 Romigi A, Liguori C, Izzi F, Albanese M, Marchi A, Mancini C, et al. Oral l-carnitine as treatment for narcolepsy without cataplexy during pregnancy: A case report. J Neurol Sci [Internet]. 2015;348(1.2):282.3. Available from: http://dx.doi.org/10.1016/j.jns.2014.11.025
  • 16 Williams SF, Alvarez JR, Pedro HF, Apuzzio JJ. Glutaric aciduria type II and narcolepsy in pregnancy. Obstet Gynecol. 2008;111(2 PART 2):522.4.
  • 17 Nishino S, Ripley B, Overeem S, Lammers GJ, Mignot E. Hypocretin (orexin) deficiency in human narcolepsy. Lancet. 2000;355(9197):39.40.
  • 18 Kuwajima M, Kono N, Horiuchi M, Imamura Y, One A, Inui Y, et al. Animal model of systemic carnitine deficiency : analysis in C3H-H-2o strain of mouse associated with juvenile visceral steatosis. 1991;174(3).
  • 19 Yoshida G, Li MX, Horiuchi M, Nakagawa S, Sakata M, Kuchiiwa S, et al. Fasting-induced reduction in locomotor activity and reduced response of orexin neurons in carnitine-deficient mice. Neurosci Res. 2006;55(1):78.86.
  • 20 Tafti M, Petit B, Chollet D, Neidhart E, De Bilbao F, Kiss JZ, et al. Deficiency in short-chain fatty acid β-oxidation affects theta oscillations during sleep. Nat Genet. 2003;34(3):320.5.
  • 21 Miyagawa T, Kawashima M, Nishida N, Ohashi J, Kimura R, Fujimoto A, et al. Variant between CPT1B and CHKB associated with susceptibility to narcolepsy. 2008;
  • 22 Kuwajima M, Fujihara H, Sei H, Umehara A, Sei M, Tsuda TT, et al. Reduced carnitine level causes death from hypoglycemia: Possible involvement of suppression of hypothalamic orexin expression during weaning period. Endocr J. 2007;54(6):911.25.
  • 23 Damkier P, Broe A. First-Trimester Pregnancy Exposure to Modafinil and Risk of Congenital Malformations. JAMA - J Am Med Assoc. 2020;323(4):374.6.
  • 24 Barker EC, Flygare J, Paruthi S, Sharkey KM. Living with narcolepsy: Current management strategies, future prospects, and overlooked reallife concerns. Nat Sci Sleep. 2020;12:453.66.
  • 25 Calvo-Ferrandiz E, Peraita-Adrados R. Narcolepsy with cataplexy and pregnancy: a case.control study. J Sleep Res. 2018;27(2):268.72.
  • 26 Maurovich-Horvat E, Kemlink D, Hogl B, Frauscher B, Ehrmann L, Geisler P, et al. Narcolepsy and pregnancy: A retrospective European evaluation of 249 pregnancies. J Sleep Res. 2013;22(5):496.512.