Narcolepsy: Clinical features, co-morbidities & treatment.

Narcolepsy is a neurologic illness that typically begins in the second and third decades of life. It is chronic in nature and negatively impacts the quality of life of affected patients. The classic presentation is a tetrad of excessive daytime sleepiness, cataplexy, sleep paralysis, and hypnagogic hallucinations. The exact cause remains unknown, but there is significant evidence that hypocretin deficiency plays an integral role. Some primary conditions that result in secondary narcolepsy include traumatic brain injury, congenital disorders, tumours, and strokes. Some medical and psychiatric disorders share characteristics of narcolepsy, at times leading to diagnostic inaccuracy. Other sleep disorders are commonly co-morbid. Diagnosis relies on patient history and objective data gathered from polysomnography and multiple sleep latency testing. Treatment focuses on symptom relief through medication, education, and behavioural modification. Both classic pharmacological treatments as well as newer options have significant problems, especially because of side effects and abuse potential. Novel modalities are being examined to expand options for treatment.

[Narcolepsia]

Narcolepsy is a chronic neurologic disease whose main features are excessive daytime sleepiness and cataplexy. It is a rare disorder which is most frequently sporadic. The age of onset shows two peaks. Both genetic and environmental factors play in its pathophysiolgy. Association with a specific HLA antigen and implication of the hypocretin system are very important findings. Narcolepsy's diagnosis is based on clinical findings but polysomnographic monitoring and multiple sleep latency test are usually necessary. Treatment of narcolepsy has been substantially modified with the advent of Modafinil which is effective as amphetamine with less undesirable effects. New etiologic treatments, such as hypocretin agonists, are currently being developed

Narcolepsy in Saudi Arabia. demographic and clinical perspective of an under-recognized disorder

To assess the clinical and polysomnographic features of narcolepsy in Saudis. All patients diagnosed to have narcolepsy in the Sleep Disorders Center at King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia between March 1998 and December 2005 based on the International Classifications of Sleep Disorders Diagnostic and Coding Manual criteria were included. A data entry form collecting the demographic, clinical features, medications, referring specialty, prior diagnoses and daytime sleepiness was used. All patients underwent polysomnography followed by multiple sleep latency. Forty-seven patients with a mean age of 28.9 +/- 1.9 years were included. The mean age at onset of symptoms was 20.5 +/- 1.4 years. The interval between symptoms onset and diagnosis was 8.4 +/- 1.2 years. While 22 [46.8%] of the patients were referred to the sleep disorders clinic by different specialties, 25 [53.2%] patients sought an appointment in the sleep disorders clinic directly. Only 3 patients were referred with the correct diagnosis. Nocturnal sleep quality was worse in narcoleptics with cataplexy compared to those without cataplexy. Saudi patients with narcolepsy have the same clinical presentation as reported in the Western literature. Narcoleptics with cataplexy had disturbed quality compared to narcoleptics without cataplexy. A long time was reported between symptoms onset and diagnosis, which may reflect the under-recognition of the problem among physicians