Sleep attacks, while being characteristic of narcolepsy, have been reported in several metabolic and central nervous system disorders--most of which are refractory to treatment. We have recently treated a 47-year-old man with disabling sleep attacks who was found to have atlantoaxial dislocation. Despite narrowing of the sagittal cervical canal diameter to 12 mm (behind the dens), symptoms of spinal cord compression were mild and intermittent, while signs were absent. Posterior fusion of the C-1 and C-2 vertebrae resulted in relief of symptoms. We suggest that this sleep disorder was a function of impaired efferent control of respiration.
Mesh-terms: Axons; Cervical Atlas; Cervical Vertebrae :: surgery; Diagnosis, Differential; Humans; Male; Middle Aged; Narcolepsy :: diagnosis; Neurons, Efferent; Sleep Disorders :: diagnosis; Sleep Disorders :: etiology; Sleep Disorders :: surgery; Spinal Cord Compression :: complications; Spinal Cord Compression :: diagnosis; Spinal Cord Compression :: surgery; Spinal Fusion;
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1Dalhousie University, Halifax, Nova Scotia, Canada.
The numbers of specialists who are practicing Clinical Pharmacology is declining. This raises questions about the nature of the discipline and the roles of those who practice Clinical Pharmacology. Numbers and qualifications of successful trainees in North American accredited Clinical Pharmacology training programs are presented. Questions are posed that require discussion by a forum of academic, regulatory, and industry-based scientists to enable Clinical Pharmacology training programs to meet the clinical care, drug development, and drug policy needs in Western countries in the next decade.Clinical Pharmacology & Therapeutics (2007) 81, 305-308. doi:10.1038/sj.clpt.6100068.