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홍차넷
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티타임
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- 다양한 주제에 대해 자유롭게 글을 작성하는 게시판입니다.
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전체기타일상/생각꿀팁/강좌방송/연예도서/문학영화의료/건강문화/예술경제생활체육과학/기술철학/종교정치요리/음식역사여행육아/가정IT/컴퓨터음악창작게임스포츠사회오프모임
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| Date |
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| Name | 모모스 |
| Subject | 기면증과 Modafinil ( 왜 감기약을 먹으면 졸릴까?) |
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기면증 (Narcolepsy) 영화에서 보면 일상생활 중 갑자기 쓰러져서 자버리는 사람들이 나오죠. 저희들도 전날 밤늦게까지 음주가무를 즐기고 난 후나 열심히 일하거나 또는 공부하고 나면 다음날 픽픽 쓰러지기는 하는데 이와 달리 전날 밤에 충분히 잠을 잤음에도 불구하고 일상 시간에 제어할 수 없는 졸음에 빠지는 사람들도 있습니다. 수면이 발작처럼 발생하여 "수면발작"이라도 불리우며 기면증 환자들에게 나타나는 일반적인 증상입니다. 수면발작이 대표적인 증상이나 환자마다 증상의 강도나 빈도 등이 상이하게 나타나고 편의상 모두 기면증환자로 분류하지만 역시 보통 다른 뇌질환처럼 다양한 원인에 의해서 발생하고 그 원인 자체도 불분명한 경우가 많습니다. 심지어 기면증에 사용되는 약물도 여타의 정신치료약물들과 비슷하게 효과는 탁월하지만 그 작용 기전이 모두 밝혀지지 않았고 일부는 불분명한 경우도 많습니다. REM (Rapid Eye Movement) 수면 수면단계는 1. 얕은 수면 - 2. 비REM수면 - 3. REM수면 순으로 이루어져 있습니다. REM수면이 중요한데 깨어 있는 것에 거의 가까운 얕은 수면과 비슷하며 심지어 REM수면시 실제 뇌의 신경 활동이 깨어 있을 때랑 거의 비슷합니다. 수많은 기억들이 REM수면 동안 재구성되어 통합되기도 하고 끊임없이 수많은 신경자극들이 발생하여(정밀기계가 부팅후 자가 점검하듯이) 뇌발달에 영향을 미친다고 알려져 있습니다. (뇌 발달이 활발한 신생아는 절대 수면시간도 많지만 수면시간 중 80%이상이 REM수면이고 나이가 들어가면서 그 비율이 줄어가는데 성인들은 전체 수면 중 20~25% 정도가 REM수면이라고 합니다.) 프로비질 (Modafinil) 기면증 환자들은 REM수면 비중이 커서 일반인들과 달리 잠에 들면 곧바로 REM수면에 돌입합니다. 수면시간 중에 뇌의 활동성이 큰 REM수면 비중이 커서 잠을 충분히 자고 나서도 실제 뇌의 휴식이 부족하고 이로 인해 일상시간에 뇌가 순간순간 기절현상이 일어나기도 합니다. 바로 이것이 수면발작의 원인이라고 추측합니다. 따라서 기면증 환자들은 일상시간에 수면 발작을 일으키지 않게 항상 뇌를 자극하여 잠에 들지 않게 각성하도록 일정 시간동안 효과가 있는 신경흥분제 (Psychoactive stimulant) 를 투여해 주기도 합니다. 이에 일상 시간에 잠들지 않았던 뇌가 그에 대한 보상효과로 밤에는 정상적인 수면이 되도록 유도하는 것이지요. 실제 뇌의 신경전달 물질인 도파민과 구조가 비슷한 암페타민 (필로폰류) 등의 마약성 신경흥분제 (Psychoactive stimulant) 들이 기면증에 사용되기도 했으나 의존성 때문 현재는 많이 사용하지 않고 중독성도 적고 효과도 좋으며 작용시간도 적당한 Modafinil (프로비질) 이 많이 사용됩니다. 프로비질 (Modafinil) 역시 정확한 작용기전을 다 설명할 수는 없으나 알려진 바만 간단히 소개하면 뇌의 신경전달 물질인 dopamine, norepinephrine, glutamate, GABA 등과 매개하는 시스템과 연관이 있고 앞서 말씀드린 REM수면, 비REM수면, 깨여있음을 조절하는 메커니즘인 Orexin/Hypocretin and Histamine Systems라는 것과 밀접한 연관이 있습니다.  이 시스템도 모두 밝혀져 있지는 않지만 기면증은 이 시스템에서 중요한 역할을 하는 Orexin receptor (OX1R, OX2R) 관련된 전달 시스템이 자가면역질환으로 이상이 생겨 발생하는 것으로 알려져 있습니다. 즉 수면을 억제하는 Orexin시스템이 이상이 생기면 깨어있음에서 비REM수면으로 또 REM수면으로 신속하게 이행하게 됩니다. 따라서 기면증 환자들은 잠을 자도 신속하게 REM수면에 빠지고 또 일상생활 중에 갑자기 잠을 자게 되는 것입니다. 프로비질 (Modafinil) 이 Histamine 의 분비를 증가시키고 Histamine이 Orexin시스템을 자극해서 잠에 들지 않게 만드는 것으로 예상하고 있습니다. (따라서 코감기약이나 종합감기약에 많이 함유된 diphenhydramine 같은 항히스타민제들을 먹으면 Histamine 분비가 억제되고 Orexin시스템도 활성화되지 않으니 졸리는 것은 당연합니다. )  기면증 환자들은 매일 먹어야하는 약으로 1알에 3000원 가량 하는 매우 고가의 약입니다. 다만 기면증으로 확진이 나면 보험적용뿐아니라 희귀병질환 및 본인부담특례코드가 나와서 실제 1/10 이하로 구매가능합니다. Warning: Use of undefined constant no - assumed 'no' (this will throw an Error in a future version of PHP) in /home/redtea/html/a_skin/bbsd/view.php on line 133 Warning: Use of undefined constant no - assumed 'no' (this will throw an Error in a future version of PHP) in /home/redtea/html/a_skin/bbsd/view.php on line 146 Warning: Use of undefined constant vote - assumed 'vote' (this will throw an Error in a future version of PHP) in /home/redtea/html/a_skin/bbsd/view.php on line 161 0 이 게시판에 등록된 모모스님의 최근 게시물
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Warning: Use of undefined constant HTTP_HOST - assumed 'HTTP_HOST' (this will throw an Error in a future version of PHP) in /home/redtea/html/pb/cmt_replace.php on line 3
Warning: Use of undefined constant ismember - assumed 'ismember' (this will throw an Error in a future version of PHP) in /home/redtea/html/a_skin/bbsd/view_comment.php on line 6
Warning: Use of undefined constant file_name - assumed 'file_name' (this will throw an Error in a future version of PHP) in /home/redtea/html/a_skin/bbsd/view_comment.php on line 28
Warning: Use of undefined constant no - assumed 'no' (this will throw an Error in a future version of PHP) in /home/redtea/html/a_skin/bbsd/view_comment.php on line 65
52147 class="iamcmt" style="display:none;"> Warning: Use of undefined constant no - assumed 'no' (this will throw an Error in a future version of PHP) in /home/redtea/html/a_skin/bbsd/view_comment.php on line 66
52147 class='vcm '>
Warning: Use of undefined constant x - assumed 'x' (this will throw an Error in a future version of PHP) in /home/redtea/html/a_skin/bbsd/view_comment.php on line 70
Warning: Use of undefined constant x - assumed 'x' (this will throw an Error in a future version of PHP) in /home/redtea/html/a_skin/bbsd/view_comment.php on line 71
Warning: Use of undefined constant no - assumed 'no' (this will throw an Error in a future version of PHP) in /home/redtea/html/a_skin/bbsd/view_comment.php on line 76
Warning: Use of undefined constant ismember - assumed 'ismember' (this will throw an Error in a future version of PHP) in /home/redtea/html/a_skin/bbsd/view_comment.php on line 117
Warning: Use of undefined constant ismember - assumed 'ismember' (this will throw an Error in a future version of PHP) in /home/redtea/html/a_skin/bbsd/view_comment.php on line 118
Warning: Use of undefined constant ismember - assumed 'ismember' (this will throw an Error in a future version of PHP) in /home/redtea/html/a_skin/bbsd/view_comment.php on line 119
Warning: Use of undefined constant ismember - assumed 'ismember' (this will throw an Error in a future version of PHP) in /home/redtea/html/a_skin/bbsd/view_comment.php on line 120
Warning: Use of undefined constant ismember - assumed 'ismember' (this will throw an Error in a future version of PHP) in /home/redtea/html/a_skin/bbsd/view_comment.php on line 121
52147'> Toby
Warning: Use of undefined constant mod_date - assumed 'mod_date' (this will throw an Error in a future version of PHP) in /home/redtea/html/a_skin/bbsd/view_comment.php on line 133
Warning: Use of undefined constant no - assumed 'no' (this will throw an Error in a future version of PHP) in /home/redtea/html/a_skin/bbsd/view_comment.php on line 140
Warning: Use of undefined constant no - assumed 'no' (this will throw an Error in a future version of PHP) in /home/redtea/html/a_skin/bbsd/view_comment.php on line 140
Warning: Use of undefined constant reg_date - assumed 'reg_date' (this will throw an Error in a future version of PHP) in /home/redtea/html/a_skin/bbsd/view_comment.php on line 142
16/08/24 13:53
52147>삭제 주소복사
Warning: Use of undefined constant level - assumed 'level' (this will throw an Error in a future version of PHP) in /home/redtea/html/a_skin/bbsd/view_comment.php on line 150
RAM수면이 아니었군요.
왜 RAM이라고 생각했었지...
Warning: Use of undefined constant level - assumed 'level' (this will throw an Error in a future version of PHP) in /home/redtea/html/a_skin/bbsd/view_comment.php on line 158
Warning: Use of undefined constant password - assumed 'password' (this will throw an Error in a future version of PHP) in /home/redtea/html/a_skin/bbsd/view_comment.php on line 166
Warning: Use of undefined constant vote - assumed 'vote' (this will throw an Error in a future version of PHP) in /home/redtea/html/a_skin/bbsd/view_comment.php on line 171
Warning: Use of undefined constant vote - assumed 'vote' (this will throw an Error in a future version of PHP) in /home/redtea/html/a_skin/bbsd/view_comment.php on line 172
Warning: Use of undefined constant vote - assumed 'vote' (this will throw an Error in a future version of PHP) in /home/redtea/html/a_skin/bbsd/view_comment.php on line 172
Warning: Use of undefined constant no - assumed 'no' (this will throw an Error in a future version of PHP) in /home/redtea/html/a_skin/bbsd/view_comment.php on line 173
Warning: Use of undefined constant no - assumed 'no' (this will throw an Error in a future version of PHP) in /home/redtea/html/a_skin/bbsd/view_comment.php on line 173
Warning: Use of undefined constant vote - assumed 'vote' (this will throw an Error in a future version of PHP) in /home/redtea/html/a_skin/bbsd/view_comment.php on line 173
왜 RAM이라고 생각했었지...
Warning: Use of undefined constant level - assumed 'level' (this will throw an Error in a future version of PHP) in /home/redtea/html/a_skin/bbsd/view_comment.php on line 158
Warning: Use of undefined constant password - assumed 'password' (this will throw an Error in a future version of PHP) in /home/redtea/html/a_skin/bbsd/view_comment.php on line 166
Warning: Use of undefined constant vote - assumed 'vote' (this will throw an Error in a future version of PHP) in /home/redtea/html/a_skin/bbsd/view_comment.php on line 171
Warning: Use of undefined constant vote - assumed 'vote' (this will throw an Error in a future version of PHP) in /home/redtea/html/a_skin/bbsd/view_comment.php on line 172
Warning: Use of undefined constant vote - assumed 'vote' (this will throw an Error in a future version of PHP) in /home/redtea/html/a_skin/bbsd/view_comment.php on line 172
Warning: Use of undefined constant no - assumed 'no' (this will throw an Error in a future version of PHP) in /home/redtea/html/a_skin/bbsd/view_comment.php on line 173
Warning: Use of undefined constant no - assumed 'no' (this will throw an Error in a future version of PHP) in /home/redtea/html/a_skin/bbsd/view_comment.php on line 173
Warning: Use of undefined constant vote - assumed 'vote' (this will throw an Error in a future version of PHP) in /home/redtea/html/a_skin/bbsd/view_comment.php on line 173
52147>
52147>
