In a normal sleep cycle, a person enters rapid eye movement (REM) sleep after about 60 to 90 minutes. Other symptoms may include sudden muscle weakness while awake that makes a person go limp or unable to move (cataplexy), vivid dream-like images or hallucinations, and total paralysis just before falling asleep or just after waking up (sleep paralysis). People may unwillingly fall asleep even if they are in the middle of an activity like driving, eating, or talking. Narcolepsy can greatly affect daily activities. Many individuals with narcolepsy also experience uneven and interrupted sleep that can involve waking up frequently during the night. People with narcolepsy may feel rested after waking, but then feel very sleepy throughout much of the day. I think they need to have a patient understanding of pathophysiology and the downstream effects of this orexin deficiency and why we choose the medicines we choose.Narcolepsy is a chronic neurological disorder that affects the brain's ability to control sleep-wake cycles. But I think it’s important for them to understand quantitatively how sleepy they are, but also understand what’s happening. We always have to clinically correlate and see what the environment is. This would be the discussion I would have with her and her family. If she was under that age bracket, oxybate, whether it’s sodium oxybate, low-sodium oxybate, and potentially there’s this new, emerging once-a-night oxybate that’s going to be coming out soon. It’s the only FDA-approved option for age 7 and above, for pediatric cases of narcolepsy. Now she’s 18, so she’s technically an adult, but if she were 15, what do you think would be the drug of choice?Īsim Roy, MD: We would have to go with oxybate. There is a drug available to treat cataplexy in a teenager. If you get the flu or mononucleosis, and you kill the bug, and if you have HLA DQB1*0602 positivity, your HLA phenotype is right, and all the stars align, you might knock out those orexin neurons and develop type 1 narcolepsy. The autoimmune system is revved up at that age. Part of that as you pointed out is related to the autoimmune system. I think it’s good to point out that the peak incidence of narcolepsy is right around age 15 or 16. She knew she was falling asleep in class, but quantitatively, she didn’t know. Bogan, MD, FCCP, FAASM: The thing is that this poor girl didn’t realize she was sleepy. All the REM vivid phenomena, vivid dreaming, this is classic type 1 narcolepsy. It could still be partial seizures, but again, the probability of having that long of a duration and still being aware of your environment and bilateral, it’s most likely cataplexy. But you combine that with this startle response with atonia, and still being aware of her environment when she collapses or melts into the ground, is kind of that classic cataplexy description, where it’s ruled out syncope, ruled out most likely generalized seizure at least. Obviously, the excessive daytime sleepiness is not unique to only narcolepsy. Bogan, MD, FCCP, FAASM: Can you explain what was going on?Īsim Roy, MD: This sounds pretty classic for type 1 narcolepsy. She was treated for attention deficit disorder as well with methylphenidate, but she was normal otherwise. But she described these vivid dreams, colorful dreams, and she had episodes of panic attacks at night when she would wake up and would panic and feel as if she couldn’t breathe. She was seen by a cardiologist for arrhythmia, and eventually seen by a neurologist for a seizure disorder, and by a psychiatrist as well. She developed all these personality changes, was irritable and depressed, and all of this, worrying about whether she can go to college or not. She can still hear him laughing, she hasn’t fainted, she has just lost muscle tone. It lasts only a minute or so, and she doesn’t fall, she just melts into the floor. ![]() Then she has these spells where her brother likes to surprise her, her brother sneaks up and surprises her, and she collapses, and completely loses muscle tone. She’s very smart, but her performance has been worse because she can’t stay awake for the exams and classes. She’s fallen asleep in class in high school. Her Epworth Sleepiness Scale score is around 18. She’s worried about whether she can go to college because she has profound daytime sleepiness. Bogan, MD, FCCP, FAASM: I’m going to throw a couple of cases at you real quick, and I’m not going to go into great detail, but the one that comes to mind is an 18-year-old female.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |