![]() ![]() (8) Sleep inertia, the need for multiple alarm clocks, and long but unrefreshing daytime naps are more indicative of idiopathic hypersomnia. (7) A clinical history of frequent hypnagogic/hypnopompic hallucinations, frequent sleep paralysis, fragmented nocturnal sleep, or positive HLA DQB1*06:02 typing may increase the likelihood of Na-2. (6) In patients without cataplexy, we recommend measuring CSF hypocretin to distinguish Na-1 from Na-2. ![]() (5) According to ICSD-3 criteria, one SOREMP within 15 minutes of sleep onset on the preceding nocturnal PSG can be included in the total SOREMP count. ![]() For example, antidepressants should be discontinued at least 3 weeks prior to the sleep studies. (4) MSLT should be performed according to AASM guidelines, and medications that might alter sleep pressure or REM sleep should be discontinued well in advance. Long sleepers should be allowed to sleep up to 10 hours. (3) During the nocturnal PSG, the patient should be permitted their habitual amount of sleep, which will usually be more than 6 hours of sleep. If the habitual sleep schedule is a concern, it may be helpful to schedule the MSLT just after 1-2 weeks' vacation to provide an opportunity for adequate sleep on a regular schedule. (2) Sleep logs or preferably actigraphy over 14 days should be performed before the PSG and MSLT to exclude ISS or shift work. Children with Na-2 should receive a more extensive workup for unusual causes of sleepiness (e.g., tumors, metabolic disorders, seizures). Suggested laboratory parameters include a full iron panel, complete blood count, vitamin B12, and thyroid markers (TSH, T4). (1) In patients with an atypical history or neurological deficits, other causes of narcolepsy-like findings should be considered, and a brain MRI should be performed. ISS, insufficient sleep syndrome (chronic sleep deprivation) CSF, cerebrospinal fluid EDS, excessive daytime sleepiness ESS, Epworth Sleepiness Scale MSL, mean sleep latency MSLT, multiple sleep latency test SOREMP, sleep onset rapid eye movement sleep. Proposed algorithm for the diagnosis of narcolepsy without cataplexy and its differential diagnoses. Insomnia multiple sleep latency test narcolepsy polysomnography. Finally, measurement of hypocretin levels can helpful, as levels are low to intermediate in 10% to 30% of narcolepsy without cataplexy patients. A short REM sleep latency (≤ 15 minutes) on polysomnography can aid in the diagnosis of narcolepsy without cataplexy, although sensitivity is low. The multiple sleep latency test remains the most important measure, and prior sleep deprivation, shift work, or circadian disorders should be excluded by actigraphy or sleep logs. A detailed clinical history is mainly helpful to rule out other possible causes of chronic sleepiness. To aid in the identification of narcolepsy without cataplexy, we review key indicators of narcolepsy and present a diagnostic algorithm. In this report, we review the clinical and physiological aspects of narcolepsy without cataplexy, the limitations of available diagnostic procedures, and the differential diagnoses, and we propose an approach for more accurate diagnosis of narcolepsy without cataplexy.Ī group of clinician-scientists experienced in narcolepsy reviewed the literature and convened to discuss current diagnostic tools, and to map out directions for research that should lead to a better understanding and more accurate diagnosis of narcolepsy without cataplexy. 11 Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.ĭiagnosing narcolepsy without cataplexy is often a challenge as the symptoms are nonspecific, current diagnostic tests are limited, and there are no useful biomarkers.10 Department of Biomedical and Neuromotor Neurological Sciences, University of Bologna, and IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy.9 Sleep Medicine Children's National Med Center, Washington, DC.8 Tokyo Metropolitan Institute of Sleep Science, Tokyo, Japan.7 National Reference Network for Orphan Diseases (Narcolepsy), Department of Neurology, Hôpital Gui de Chauliac, CHU Montpellier, INSERM U1061, France.6 Department of Neurology and Program in Sleep, Emory University School of Medicine, Atlanta.5 Hôpital Pitié-Salpêtrière, Pierre and Marie Curie University, Paris, France.4 Department of Neurology, Radboud University Medical Center, Nijmegen, The Netherlands.3 Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands.2 Stanford Center for Sleep Sciences, Stanford University, Stanford, CA.1 Department of Neurology, University Hospital Zurich, Zurich, Switzerland Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA. ![]()
0 Comments
Leave a Reply. |