Orgasmolepsy in Narcolepsy Type 1 Responsive to Pitolisant: A Case Report

Overview

Journal Nat Sci Sleep

Publisher Dove Medical Press

Date 2021 Jan 7

PMID 33408544

Authors

Gaia Pellitteri

Pierluigi Dolso

Mariarosaria Valente

Gian Luigi Gigli

Affiliations

Soon will be listed here.

Abstract

We describe a case of a young male patient with narcolepsy type 1 (NT1), who developed generalized cataplexy attacks during sexual intercourses, on which we have obtained a satisfactory control with pitolisant. Orgasmolepsy is an uncommon feature of NT1 that has been poorly described in the literature. The prevalence of this condition is unclear, as it is reasonably underreported by patients for embarrassment and not well investigated by physicians. Pitolisant is a novel treatment for narcolepsy, effective on excessive daytime sleepiness and cataplexy by modulating the histaminergic system. Real-world data collection on pitolisant efficacy and safety is still ongoing. However, pitolisant effectiveness on orgasmolepsy in NT1 has no precedent in the literature. Orgasmolepsy and other sexual disturbances should be actively searched in narcoleptic patients and, if present, may guide clinicians to prefer pitolisant or sodium oxybate, avoiding antidepressants for their possible sexual side effects.

References

Szakacs Z, Dauvilliers Y, Mikhaylov V, Poverennova I, Krylov S, Jankovic S . Safety and efficacy of pitolisant on cataplexy in patients with narcolepsy: a randomised, double-blind, placebo-controlled trial. Lancet Neurol. 2017; 16(3):200-207. DOI: 10.1016/S1474-4422(16)30333-7. View

Barateau L, Chenini S, Evangelista E, Jaussent I, Lopez R, Dauvilliers Y . Clinical autonomic dysfunction in narcolepsy type 1. Sleep. 2019; 42(12). DOI: 10.1093/sleep/zsz187. View

Bassetti C, Adamantidis A, Burdakov D, Han F, Gay S, Kallweit U . Narcolepsy - clinical spectrum, aetiopathophysiology, diagnosis and treatment. Nat Rev Neurol. 2019; 15(9):519-539. DOI: 10.1038/s41582-019-0226-9. View

Montejo A, Llorca G, Izquierdo J, Rico-Villademoros F . Incidence of sexual dysfunction associated with antidepressant agents: a prospective multicenter study of 1022 outpatients. Spanish Working Group for the Study of Psychotropic-Related Sexual Dysfunction. J Clin Psychiatry. 2001; 62 Suppl 3:10-21. View

Ping L, Yat F, Yun Kwok W . Status cataplecticus leading to the obstetric complication of prolonged labor. J Clin Sleep Med. 2007; 3(1):56-7. View

Lopes E, Pereira D, da Silva Behrens N, de Almeida Fonseca H, Calvancanti P, de Araujo Lima T . Cataplexy as a side effect of modafinil in a patient without narcolepsy. Sleep Sci. 2015; 7(1):47-9. PMC: 4521649. DOI: 10.1016/j.slsci.2014.07.015. View

De Biase S, Pellitteri G, Gigli G, Valente M . Evaluating pitolisant as a narcolepsy treatment option. Expert Opin Pharmacother. 2020; 22(2):155-162. DOI: 10.1080/14656566.2020.1817387. View

Dauvilliers Y, Siegel J, Lopez R, Torontali Z, Peever J . Cataplexy--clinical aspects, pathophysiology and management strategy. Nat Rev Neurol. 2014; 10(7):386-95. PMC: 8788644. DOI: 10.1038/nrneurol.2014.97. View

Szucs A, Janszky J, Hollo A, Migleczi G, Halasz P . Misleading hallucinations in unrecognized narcolepsy. Acta Psychiatr Scand. 2003; 108(4):314-6; dicussion 316-7. DOI: 10.1034/j.1600-0447.2003.00114.x. View

10.

Vignatelli L, Antelmi E, Ceretelli I, Bellini M, Carta C, Cortelli P . Red Flags for early referral of people with symptoms suggestive of narcolepsy: a report from a national multidisciplinary panel. Neurol Sci. 2018; 40(3):447-456. PMC: 6433801. DOI: 10.1007/s10072-018-3666-x. View

11.

Poryazova R, Khatami R, Werth E, Bassetti C . Weak with sex: sexual intercourse as a trigger for cataplexy. J Sex Med. 2009; 6(8):2271-7. DOI: 10.1111/j.1743-6109.2009.01328.x. View