title: Narcolepsy: clinical approach to etiology, diagnosis, and treatment.
abstract: Narcolepsy is a neurologic disorder characterized by excessive daytime sleepiness and         manifestations of disrupted rapid eye movement sleep stage. The pathologic hallmark         is loss of hypocretin neurons in the hypothalamus likely triggered by environmental         factors in a susceptible individual. Patients with narcolepsy, in addition to excessive         daytime sleepiness, can present with cataplexy, sleep paralysis, sleep fragmentation,         and hypnagogic/hypnopompic hallucinations. Approximately 60% to 90% of patients         with narcolepsy have cataplexy, characterized by sudden loss of muscle tone. Only         15% of patients manifest all of these symptoms together. Narcolepsy can be misdiagnosed         as a psychiatric disorder or even epilepsy. An appropriate clinical history,         polysomnogram, Multiple Sleep Latency Test, and, at times, cerebrospinal fluid         hypocretin levels are necessary for diagnosis. The treatment of narcolepsy is aimed         toward the different symptoms that the patient manifests. Excessive daytime sleepiness         is treated with amphetamine-like or non-amphetamine-like stimulants. Cataplexy is         treated with sodium oxybate, tricyclic antidepressants, or selective serotonin and norepinephrine         reuptake inhibitors. Sleep paralysis, hallucinations, and fragmented sleep         may be treated with benzodiazepine hypnotics or sodium oxybate. Patients with         narcolepsy should avoid sleep deprivation, sleep at regular hours, and, if possible,         schedule routine napping.
authors.affiliation: Comprehensive Epilepsy Center, SUNY Downstate Medical Center, Brooklyn, NY, USA.
authors.forename: Ewa I
authors.initials: EI
authors.lastname: Koziorynska
authors.forename: Alcibiades J
authors.initials: AJ
authors.lastname: Rodriguez
mesh_terms: D000818:Animals; D002385:Cataplexy / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D000697:Central Nervous System Stimulants / Q000627:therapeutic use; D006212:Hallucinations / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D006801:Humans; D009290:Narcolepsy / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D020188:Sleep Paralysis / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D016896:Treatment Outcome
chemical_list: D000697:Central Nervous System Stimulants