Narcolepsy - NORD (National Organization for Rare Disorders)
In narcolepsy, the normal boundary between awake and asleep is blurred, For example, cataplexy is the muscle paralysis of REM sleep occurring during. and without cataplexy, from a University sleep disorders center. Consecutive relationships (71% men, 44% women, p = ) and physical activity (36% men . Among patients with narcolepsy, 68 (%) of partici- pants were women. The Difference Between Narcolepsy Type 1 and 2 Learn about these differences, including the role of cataplexy and testing for hypocretin.
Abstract Narcolepsy and psychiatric disorders have a significant but unrecognized relationship, which is an area of evolving interest, but unfortunately, the association is poorly understood. It is not uncommon for the two to occur co-morbidly. However, narcolepsy is frequently misdiagnosed initially as a psychiatric condition, contributing to the protracted time to accurate diagnosis and treatment. Narcolepsy is a disabling neurodegenerative condition that carries a high risk for development of social and occupational dysfunction.
Deterioration in function may lead to the secondary development of psychiatric symptoms. Inversely, the development of psychiatric symptoms can lead to the deterioration in function and quality of life.
The overlap in pharmaceutical intervention may further enhance the difficulty to distinguish between diagnoses. Comprehensive care for patients with narcolepsy should include surveillance for psychiatric illness and appropriate treatment when necessary.
Further research is necessary to better understand the underlying pathophysiology between psychiatric disease and narcolepsy. Introduction Narcolepsy is a disabling neurodegenerative condition that is characterized by the pentad features of excessive daytime sleepiness EDSsleep fragmentation, sleep related hallucinations, sleep paralysis, and cataplexy; brief episodes of loss of tone frequently provoked by strong emotions.
He was a loud snorer. An electroencephalogram gave a normal recording, but he became drowsy repeatedly during the procedure. We subsequently obtained a history of disabling episodes of cataplexy: He also reported sleep paralysis and hypnagogic hallucinations.
The true nature of the tonic-clonic seizures during sleep eventually became clear: Overnight polysomnography suggested mild obstructive sleep apnoea, but a multiple sleep latency test was indicative of narcolepsy, with a mean sleep latency of 15 seconds and sleep onset rapid eye movement in all four naps.
Fluoxetine has controlled his cataplexy; stimulants for his daytime sleepiness and continuous positive airways pressure at night for his sleep apnoea have made a modest impact. Polysomnography Polysomnography involves the measurement of several physiological variables during sleep and aids the diagnosis of sleep disorders. The variables most commonly assessed are brain activity and sleep stage, using electroencephalography, muscle activity at several sites including eye movements, using surface electromyography, chest and abdominal movements related to breathing, oral or nasal airflow, heart rate using electrocardiography, and tissue oxygenation using pulse oximetry.
The main use of polysomnography in the diagnosis of narcolepsy is to exclude disorders of nocturnal sleep, such as obstructive sleep apnoea, which might explain daytime sleepiness.
- What is difference between narcolepsy and cataplexy?
- Narcolepsy and Psychiatric Disorders: Comorbidities or Shared Pathophysiology?
- Narcolepsy and Cataplexy
Case 3—A 41 year old retired social worker was referred from an epilepsy clinic. Six years before these episodes had become more sustained. Temporal lobe epilepsy was suspected. Computed tomography of the brain and an electroencephalogram gave normal results; treatment with carbamazepine was ineffective. She sometimes recognised these from recent dreams, and they tended to have a strong emotional content.
Rapid eye movement also occurred at the onset of overnight sleep. On direct questioning she admitted to daytime sleepiness, with naps at least once a day, but not to cataplexy or sleep paralysis.
Narcolepsy and Psychiatric Disorders: Comorbidities or Shared Pathophysiology?
A multiple sleep latency test showed a mean sleep latency of 11 minutes, a minimum latency of seven minutes, and two episodes of sleep onset rapid eye movement. Discussion Narcolepsy has a prevalence of around 1: The multiple sleep latency test box generally shows a reduced mean sleep latency and, usually, the occurrence of episodes of sleep onset rapid eye movement. If a patient continues to drive against medical advice it is a doctor's duty to consider informing the Driver and Vehicle Licensing Agency directly.
Research is needed to establish whether computerised tests of vigilance are useful predictors of safety at the wheel in people with narcolepsy. The multiple sleep latency test The multiple sleep latency test, often performed the day after polysomnography, quantifies daytime sleepiness by offering subjects four or five opportunities to fall asleep in a quiet dark room at two hour intervals.
Narcolepsy mistaken for epilepsy
The electroencephalogram, eye movements, and muscle tone are monitored. People with narcolepsy typically have a mean sleep latency of less than eight minutes and episodes of rapid eye movement or dreaming sleep within 10 minutes of sleep onset. The phenomenon of narcolepsy can be understood in terms of a dysregulation of rapid eye movement sleep, which is normally associated with dreaming and motor inhibition to prevent the dreams from being acted out.
Effective treatment is available.
NODSS - Narcolepsy and Cataplexy
In cases 1 and 2, diagnostic difficulty stemmed from the misinterpretation of episodes of cataplexy and daytime sleep. Partial recovery of muscle tone, with resulting twitching movements, is common during episodes of cataplexy 4: Clues to the true nature of these episodes were supplied by both patients having all the symptoms of narcolepsy, their recall for events occurring during their attacks of weakness, and the precipitation of the nocturnal attacks by sexual excitement in case 2. These cases illustrate the scope for mistaking narcolepsy for epilepsy.