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Assessing narcolepsy with cataplexy in children and adolescents: development of a cataplexy diary and the ESS-CHAD

Authors Wang YG, Benmedjahed K, Lambert J, Evans CJ, Hwang S, Black J, Johns MW

Received 21 April 2017

Accepted for publication 22 June 2017

Published 14 August 2017 Volume 2017:9 Pages 201—211


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Professor Steven A Shea

Y Grace Wang,1 Khadra Benmedjahed,2 Jérémy Lambert,2 Christopher J Evans,3 Steve Hwang,3 Jed Black,1,4 Murray W Johns5

1Clinical Development, Jazz Pharmaceuticals, Palo Alto, CA, USA; 2Patient-Centered Outcomes, Mapi, Lyon, France; 3Endpoint Outcomes, Boston, MA, USA; 4Sleep Medicine, Stanford Sleep Medicine Center, Redwood City, CA, USA; 5Epworth Sleep Centre, East Melbourne, VIC, Australia

Objective: The aim of this study was to qualitatively evaluate concepts for incorporation into a daily diary to capture cataplexy frequency and to assess the content validity of the Epworth Sleepiness Scale for Children and Adolescents (ESS-CHAD) in pediatric patients with narcolepsy.
Patients and methods: Face-to-face concept elicitation and cognitive interviews were conducted with children (7–9 years; n=13) and adolescents (10–17 years; n=16) who have narcolepsy with cataplexy, and their parents/caregivers.
Results: Similarities and differences were noted between narcolepsy concepts described by children and their parents/caregivers, suggesting some different but complementary perspectives; parents may not recognize cataplexy symptoms/triggers as well as children, but parents have greater recognition of the circumstances of falling asleep. Cataplexy diary modifications included changes in definitions and examples of cataplexy, using child-friendly terminology, adding a quantitative question to determine daily frequency, and standardizing the questionnaire for evening administration with self-completion by the child. Modifications were made to ESS-CHAD for child-friendly wording and to ensure that items reflect activities (eating, watching TV/video) and environments (school, bus/car transport) in which children are likely to participate. Two ESS-CHAD versions were proposed: one with a 1-month recall period, for general use, and the other with a recall period of “since your last study visit,” for research, which could be shorter or longer than 1 month (as short as 1 week).
Conclusion: The cataplexy diary and ESS-CHAD were modified for the assessment of children and adolescents. Further psychometric validation is recommended. These measures are being used in a Phase III, placebo-controlled clinical trial of sodium oxybate in children and adolescents with narcolepsy.

Keywords: narcolepsy, cataplexy, sleepiness, assessment, children, adolescents

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