This is a video synopsis/summary of a panel discussion involving Michael Thorpy, MD; Karl Doghramji, MD, FAASM, DFAPA; Clete Kushida, MD, PhD; and Richard K Bogan, MD.

The conversation centers on managing narcolepsy in pregnant patients, acknowledging the challenges posed by medication safety during pregnancy. The primary concern is the uncertainty surrounding the long-term effects of available medications on fetal development, particularly the risk of congenital malformations.

The first-line approach involves behavioral interventions, including optimizing sleep hygiene, daytime naps, and addressing comorbid sleep disorders like obstructive sleep apnea. Medications are generally avoided or minimized, especially in less severe cases, due to the potential risks.

Studies have shown a slight increase in the risk of congenital malformations with medications like methylphenidate and amphetamines, although the absolute risk remains relatively low. Modafinil, specifically, has been associated with a higher rate of congenital abnormalities, prompting caution in its use during pregnancy.

The panelists concur on the importance of reducing medication doses and utilizing non-pharmacological strategies such as strategic naps and cognitive therapy. Avoidance of triggering emotions for cataplexy is also discussed, although it's acknowledged as challenging. Medications like modafinil, armodafinil, solriamfetol, and pitolisant are generally avoided during pregnancy due to limited safety data.

Despite the lack of comprehensive evidence, there's a consensus that therapeutic doses of most medications pose minimal risk to fetal health, except for modafinil. The conversation underscores the necessity of individualized approaches and close monitoring to ensure the well-being of both the mother and the fetus during pregnancy.

Video synopsis is AI-generated and reviewed by NeurologyLive editorial staff.