Paeds Cases · respiratory-sleep-and-airway
Narcolepsy and hypersomnolence — structured clinical encounter
Structured encounter testing the approach to a school-aged child with three months of irresistible daytime sleepiness who loses muscle tone in the head and knees when laughing and has gained weight rapidly: the recognition of cataplexy and narcolepsy type 1, the exclusion of secondary sleepiness, the confirmatory polysomnography, multiple sleep latency test and cerebrospinal fluid orexin, the layered management of sleepiness and cataplexy, the monitoring, and the conversation with the family about a lifelong condition and its impact on school and safety.
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Station 1 — recognition
Asked for my first impression, I explain that a previously well child with three months of irresistible daytime sleepiness who loses muscle tone in the head and knees when he laughs, while staying fully aware, has cataplexy, and cataplexy is nearly specific for narcolepsy type 1. The rapid weight gain fits the hypothalamic involvement typical of paediatric narcolepsy, so I would treat this as narcolepsy type 1 until proven otherwise. [2] [9]
References14ShowHide
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- [9]Pillen S; Pizza F; Dhondt K; et al Cataplexy and Its Mimics: Clinical Recognition and Management. Curr Treat Options Neurol, 2017.PMID 28478511
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- [14]Dauvilliers Y; Lammers GJ; Lecendreux M; et al Effect of sodium oxybate on body mass index in pediatric patients with narcolepsy. J Clin Sleep Med, 2024.PMID 37942930