Get access

Psychostimulants for hypersomnia (excessive daytime sleepiness) in myotonic dystrophy

  • Review
  • Intervention

Authors

  • D Annane,

  • R Miller,

  • P Barnes


Prof Djillali Annane, Physician, Critical Care Department, Hôpital Raymond Poincaré, Assistance Publique - Hôpitaux de Paris, 104. Boulevard Raymond Poincaré, Garches, Ile de France, 92380, FRANCE. djillali.annane@rpc.ap-hop-paris.fr.

Abstract

Background

Excessive daytime sleepiness is a common symptom of myotonic dystrophy. Psychostimulants are drugs increasingly used to treat hypersomnia in myotonic dystrophy.

Objectives

To search systematically for, and combine all evidence from, randomised trials relating to the effects of psychostimulants in myotonic dystrophy patients with hypersomnia.

Search strategy

We searched the Cochrane Neuromuscular Disease Trial Register (searched May 2001) for randomised trials concerning psychostimulants in myotonic dystrophy, we searched of the bibliographies of identified papers and we contacted the authors of the papers.

Selection criteria

We considered all randomised or quasi randomised trials that have evaluated any type of psychostimulants (versus a placebo or no treatment) in children or adults with proven myotonic dystrophy and hypersomnia.

Data collection and analysis

Potentially relevant papers were scrutinised by two reviewers and the selection of eligible studies was agreed by them and a third reviewer. Data were extracted by one reviewer and checked by a second reviewer.

Main results

Primary outcome
We found no trial that assessed the effect of a psychostimulant on the results of the maintenance of wakefulness tests.
Secondary outcomes
Only one eligible trial was found. In this crossover double blind study of 10 patients with myotonic dystrophy, the efficacy of selegiline was evaluated against a placebo on the multiple sleep latency test. There was no difference between the selegiline and placebo periods in mean improvement in the multiple sleep latency test scale.

Authors' conclusions

There is no evidence to support the use of a psychostimulant to treat hypersomnia in myotonic dystrophy. Randomised trials are needed to evaluate the efficacy and safety of psychostimulants.

Plain language summary

Plain language summary

There is currently no evidence from randomised controlled trials to support the use of psychostimulants to treat excessive daytime sleepiness in myotonic dystrophy

Many patients with myotonic dystrophy complain about excessive daytime sleepiness. This symptom is related to disordered central respiratory control. Psychostimulants are drugs that increase alertness. There is a dearth of randomised trials that have evaluated the efficacy and safety of psychostimulants in myotonic dystrophy. The only study did not demonstrate any benefit from one drug, selegiline. Randomised trials are needed to determine the utility of psychostimulants for myotonic dystrophy.