| Fact | Explanation |
|---|---|
| Extreme daytime sleepiness. (EDS) [1] | Irresistible sleepiness and sleep attacks of brief duration (about 15 minutes). [2] Occurring almost daily during a period of at least six months plus a clear clinical history of cataplexy is needed for clinical diagnosis.[3] |
| Cataplexy [1] | Temporary episodes of sudden loss of muscle tone while awake or when experiencing emotions. [4] |
| Sleep paralysis [1] | Transient inability to voluntarily move or speak during sleep. Specially during the transition between sleep and wakefulness. [3] |
| Hypnagogig hallucinations [1] | Abnormal visual or auditory perceptions which are experienced while falling asleep. [3] Narcolepsy is characterized by the classic tetrad of symptoms. Which are, EDS, cataplexy, sleep paralysis and hypnagogig hallucinations. [5] |
| Secondary emotional and social difficulties [6] | Due to the symptoms of their disorder people experience embarrassment, feelings of loss of self-worth and academic decline in adolescents. They also avoid social situations that would precipitate cataplexy or draw attention to the degree of somnolence. [6] |
| Fact | Explanation |
|---|---|
| Thorough and complete neurological examination. | In order to exclude structural neurological abnormalities which can mimic narcolepsy. Except for atonia and areflexia in patients having active cataplexy, neurological examination should be normal. [1] |
| Cardiovascular examination. | Look for arrhythmias, aortic stenosis which can cause drop attacks. [2] |
| Fact | Explanation |
|---|---|
| Sleep apnea syndrome | Sleepiness due to disturbed nocturnal sleep usually associated with excessive snoring and intermittent upper airway obstruction. [1] |
| Idiopathic hypersomnia | Inability to wake up completely until several hours after getting up and prolonged nocturnal sleep but without clinical or electrophysiologic features of REM sleep disturbance as in narcolepsy. [2] Presence of cataplexy is single out narcolepsy from the other forms of hypersomnia. [4] |
| hypersomnia associated with depression | Depressive disorder is diagnosed in the presence of sad mood and/or anhedonia and four out of nine other symptoms,one of which is insomnia or hypersomnia. [3] |
| Syncopes, drop attacks, atonic attacks or attacks of a histrionic nature | When cataplexy is more predominant narcolepsy can be misdiagnosed as such. [4] |
| Epilepsy | Cataplexy can mimic certain forms of epilepsy. For example - atonic seizures. Nocturnal seizures can cause sleep disturbance, causing day time somnolence.[4] |
| Fact | Explanation |
|---|---|
| 12-lead electrocardiography and echocardiography. | To exclude cardiac causes giving rise to drop attacks. Example: Aortic stenosis. [1] |
| Brain Imaging and EEG. | When drop attacks caused by seizure episodes needed to be excluded.[1] |
| Polysomnogram- multiple sleep latency test (MSLT). | To diagnose according to diagnostic criteria. Average sleep latency < 8 minute or presence of two sleep-onset REM periods (SOREMPs) during the multiple sleep latency test (MSLT) are considered positive polygraphic abnormalities in the diagnosis. [2] |
| Nocturnal polysomnogram. | To exclude other possible causes like periodic leg movements and obstructive sleep apnea. [2] |
| HLA type diagnostic markers. | Most patients are HLA DQB1*0602 positive. Which predispose patients to the disorder. Presence of markers is supportive of the diagnosis. [3] |
| CSF hypocretin-1 measurement. | Low CSF hypocretin levels (< 110 pg/ml, one-third of mean control value) are included in the diagnostic criteria of narcolepsy. ( in the second revision of ICSD) [2] |
| Fact | Explanation |
|---|---|
| Polysomnographic test- maintenance of wakefulness test (MWT) | Is to assess the effect of treatment with psycho stimulants. [1] |
| Fact | Explanation |
|---|---|
| Explanation of the diagnosis and nature of disorder having recurrences and necessity of life long treatments. | Reassurance of the patient and prevention of accidents.[1] |
| Patient education on avoiding dangerous activities such as driving or operating machinery, and possible dangerous situations like occurrence of a drop attack while climbing stairs, swimming , and suggest suitable precautions. Example- having a companion while going on heights, having a life preserver when swimming. | Prevents accidents. [2] |
| Avoid alcohol and heavy meals. | Disturbs the sleep- wake cycle and can give rise to alcohol-dependent sleep disorder. [3] |
| Fact | Explanation |
|---|---|
| Regular/planned day time napping. | Relieves drowsiness for one or two hours. [1] |
| Maintaining regular sleep- wake patterns. | relieves daytime drowsiness. [1] The combination of planned daytime naps and maintaining regular nocturnal sleep times produce significant reduction in severity of daytime sleepiness in treated narcoleptics. [2] |
| Medical Therapy | 1) CNS stimulants - Amphetamine, Methamphetamine, Dextroamphetamine, Methylphenidate - considered main treatment for sleepiness associated with narcolepsy. 2) Non-amphetamine wakefulness promoting medication - Modafinil and Armodafinil. 3) Sodium Oxybate - Is a rapidly acting sedative. Improves cataplexy and reduces daytime somnolence. 4) Tricyclic antidepressants and fluoxetine - effective in the treatment of cataplexy. [2] |