Treatment of MS (ORP-10)

Common sleep disorders in patients with MS include sleep apnea, insomnia, RLS, narcolepsy, and RBD, typically resulting in hypersomnolence, increased fatigue, and a lowered pain threshold . Treatment of MS with immunotherapy is often associated with hypersomnolence, increasing fatigue, depression, and insomnia. MS plaques that affect the diencephalon (hypothalamic region) have also been shown to cause hypersomnia and narcoleptic symptoms in the context of low cerebrospinal fluid (CSF) hypocretin-1 (orexin-1) levels. Awareness of sleep-related problems is warranted in this patient population because these problems are extremely common and have the potential to negatively impact overall health and quality of life. Treatments of fatigue and poor sleep should include addressing any underlying sleep disorders with the appropriate therapy. In cases in which primary sleep disorders have been treated or are not present, pharmacologic therapy with amantadine, L-carnitine, modafinil, or other wake-promoting agents can be considered to target the symptoms of fatigue or hypersomnia.