title: Narcolepsy Type 1 and Idiopathic Generalized Epilepsy: Diagnostic and Therapeutic Challenges in Dual Cases.
abstract: OBJECTIVE
  The aim of this study is to describe the possible co-occurrence of narcolepsy type 1 and generalized epilepsy, focusing on diagnostic challenge and safety of dual treatments.
  
  
  RESULTS
  Four patients with comorbidity for narcolepsy type 1 and idiopathic generalized epilepsy are reported: in three cases the onset of epilepsy preceded narcolepsy type 1 appearance, whereas in one case epileptic spells onset was subsequent. Patients presented with absences, myoclonic and tonic-clonic seizure type: in the patient with tonic-clonic seizures the dual pathology was easily recognized, in the other cases the first diagnosis caused the comorbid disease to be overlooked, independent of the time-course sequence. All four patients underwent neurological examination, video-electroencephalogram during which ictal and interictal epileptic discharges were recorded, and sleep polysomnographic studies. Repeated sleep onset rapid eye movement periods (SOREMPs) were documented with the multiple sleep latency test (MLST) in all the four cases. All patients had unremarkable brain magnetic resonance imaging studies and cerebrospinal hypocretin-1 was assessed in two patients, revealing undetectable levels. The association of antiepileptic drugs and substances currently used to treat narcolepsy type 1, including sodium oxybate, was effective in improving seizures, sleep disturbance, and cataplexy.
  
  
  CONCLUSIONS
  Narcolepsy type 1 may occur in association with idiopathic generalized epilepsy, leading to remarkable diagnostic and therapeutic challenges. Electrophysiological studies as well as a comprehensive somnologic interview can help confirm the diagnosis in patients with ambiguous neurological history. Sodium oxybate in combination with antiepileptic drugs is safe and effective in treating cataplexy and excessive daytime sleepiness.
authors.affiliation: Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Bologna, Italy.
authors.forename: Simone
authors.initials: S
authors.lastname: Baiardi
authors.affiliation: Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Bologna, Italy.|IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Vandi
authors.affiliation: Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Bologna, Italy.|IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Pizza
authors.affiliation: Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Bologna, Italy.|IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy.
authors.forename: Lara
authors.initials: L
authors.lastname: Alvisi
authors.affiliation: UO Neurologia ASF 10 Firenze, Italy.
authors.forename: Lucia
authors.initials: L
authors.lastname: Toscani
authors.affiliation: Regional Epilepsy Center-Sleep Medicine Center, San Paolo Hospital, Milan, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Zambrelli
authors.affiliation: Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Bologna, Italy.|IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Tinuper
authors.affiliation: Hephata Klinik, Schwalmstadt-Treysa, Germany; Department of Neurology, Philipps-Universität Marburg, Marburg, Germany.
authors.forename: Geert
authors.initials: G
authors.lastname: Mayer
authors.affiliation: Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Bologna, Italy.|IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Plazzi
mesh_terms: D000328:Adult; D000927:Anticonvulsants / Q000627:therapeutic use; D004569:Electroencephalography; D004829:Epilepsy, Generalized / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy*; D006801:Humans; D008297:Male; D009290:Narcolepsy / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy*; D017286:Polysomnography; D012978:Sodium Oxybate / Q000627:therapeutic use; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000927:Anticonvulsants; D012978:Sodium Oxybate
keywords: epilepsy; narcolepsy type 1; sodium oxybate; video-EEG