Narcolepsy and hypersomnolence disorders

Meet the patient

A 19-year-old university student reaches your clinic labelled "treatment-resistant depression" after three SSRIs. The real story: she falls asleep in every lecture, her naps refresh her for an hour, and her knees buckle when she laughs — once into a swimming pool. Last week she drifted across lanes on the freeway and only the rumble strip woke her. She sees frightening figures as she drops off, and some mornings she cannot move for a few seconds on waking.^[1][2]

Every registrar reaches for another SSRI or a stimulant screen. Every examiner asks two questions: "What is the diagnosis, and what is the single most dangerous thing about it tonight?" This topic is the answer.^[1][7]

References16ShowHide

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3. [3]Thannickal TC, Moore RY, Nienhuis R, et al. Reduced number of hypocretin neurons in human narcolepsy Neuron, 2000.PMID 11055430
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7. [7]Bassetti CLA, Kallweit U, Vignatelli L, et al. European guideline and expert statements on the management of narcolepsy in adults and children J Sleep Res, 2021.PMID 34173288
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11. [11]US Modafinil in Narcolepsy Multicenter Study Group Randomized trial of modafinil as a treatment for the excessive daytime somnolence of narcolepsy Neurology, 2000.PMID 10720292
12. [12]US Xyrem Multicenter Study Group A randomized, double blind, placebo-controlled multicenter trial comparing the effects of three doses of orally administered sodium oxybate with placebo for the treatment of narcolepsy Sleep, 2002.PMID 11833860
13. [13]Dauvilliers Y, Bassetti C, Lammers GJ, et al. Pitolisant versus placebo or modafinil in patients with narcolepsy: a double-blind, randomised trial Lancet Neurol, 2013.PMID 24107292
14. [14]Thorpy MJ, Shapiro C, Mayer G, et al. A randomized study of solriamfetol for excessive sleepiness in narcolepsy Ann Neurol, 2019.PMID 30694576
15. [15]Partinen M, Kornum BR, Plazzi G, et al. Narcolepsy as an autoimmune disease: the role of H1N1 infection and vaccination Lancet Neurol, 2014.PMID 24849861
16. [16]Billiard M, Sonka K Idiopathic hypersomnia Sleep Med Rev, 2016.PMID 26599679