J Korean Child Neurol Soc.  2009 Nov;17(2):107-117.

Pediatric Narcolepsy: Diagnosis and Treatment

• Bang YW
• Chae KY

Abstract

Narcolepsy is chronic devastating disease that characterized by excessive daytime sleepiness, cataplexy, which often precipitated by intense emotion or excitement, hypnagogic, or hypnapompic hallucinations, sleep paralysis and nocturnal disrupted sleep. In child onset narcolepsy, the presentations of narcolepsy can be very variable, making misdiagnosis as seizure disorders or delaying diagnosis as much as several years after disease onset. For the diagnosis of narcolepsy, overnight polysomnography(PSG) and multiple sleep latency test(MSLT) should be evaluated. Test for Cerebrospinal fluid hypocretin(orexin) concentration and human leukocyte antigens(HLA) would be great helpful to confirm the narcolepsy with cataplexy even in early stage of disease in children. The mainstays of treatment are that reducing the excessive daytime sleepiness, preventing the intrusion of the REM related phenomena including cataplexy and consolidating the nighttime sleep. Central nervous system stimulators such as methylphenidate or amphetamine decrease excessive daytime sleepiness and tricyclic antidepressant(TCA) or selective serotonin reuptake inhibitors(SSRI) can prevent cataplexy. Recently, new therapeutic agents such as modafinil and sodium oxybate are emerging in clinical practice with much effectiveness. Counseling for poor school performance, social isolation and depression should be provided. Early diagnosis and treatment can greatly improve the quality of life. Awareness of excessive daytime sleepiness in children or adolescent will allow pediatricians to effectively identify hypersomnia such as narcolepsy.

Keyword

Narcolepsy; Diagnosis; Treatment; Children; Adolescents

MeSH Terms

Adolescent
Amphetamine
Benzhydryl Compounds
Cataplexy
Central Nervous System
Child
Counseling
Depression
Diagnostic Errors
Disorders of Excessive Somnolence
Early Diagnosis
Epilepsy
Hallucinations
Humans
Leukocytes
Methylphenidate
Narcolepsy
Quality of Life
Serotonin
Sleep Paralysis
Social Isolation
Sodium Oxybate
Amphetamine
Benzhydryl Compounds
Methylphenidate
Serotonin
Sodium Oxybate