Narcolepsy In Children Research Articles

Role of New Drug Delivery System in Brain Disorder: Narcolepsy

Narcolepsy is a chronic neurological disorder that involves a decreased ability to regulate sleep wake cycles. In this review authors highlighted various types of narcolepsy, the most common symptoms of the narcolepsy, symptoms of the narcolepsy in children, various causes of narcolepsy, how it effects, how common is narcolepsy, stages of narcolepsy, diagnosis of narcolepsy, its treatment and cure, complications associated with its treatment. The brain is shielded with blood brain barrier system and the methods that can enhance drug delivery to the brain are of great interest in treatment of various brain related problems. Novel drug delivery specially targeted drug delivery is a method by which localizing and maximizing drugs at their desired site of action to reduce toxicity and increase treatment efficiency. This review intends to detail new drug delivery system over conventional drug delivery system, brain targeted drug delivery, challenges faced while making targeted drug delivery system for brain, various strategies and advances in targeted drug delivery for the treatment of narcolepsy.

Sleep Stage Transitions and Sleep-Dependent Memory Consolidation in Children with Narcolepsy-Cataplexy.

Electroencephalographic sleep stage transitions and altered first REM sleep period transitions have been identified as biomarkers of type 1 narcolepsy in adults, but not in children. Studies on memory complaints in narcolepsy have not yet investigated sleep-dependent memory consolidation. We aimed to explore stage transitions; more specifically altered REM sleep transition and its relationship with sleep-dependent memory consolidation in children with narcolepsy. Twenty-one children with narcolepsy-cataplexy and twenty-three healthy control children completed overnight polysomnography and sleep-dependent memory consolidation tests. Overnight transition rates (number of transitions per hour), global relative transition frequencies (number of transitions between a stage and all other stages/total number of transitions × 100), overnight transitions to REM sleep (transition from a given stage to REM/total REM transitions × 100), and altered first REM sleep period transitions (transitions from wake or N1 to the first REM period) were computed. Narcoleptic children had a significantly higher overnight transition rate with a higher global relative transition frequencies to wake. A lower sleep-dependent memory consolidation score found in children with narcolepsy was associated with a higher overnight transition frequency. As observed in narcoleptic adults, 90.48% of narcoleptic children exhibited an altered first REM sleep transition. As in adults, the altered sleep stage transition is also present in children with narcolepsy-cataplexy, and a higher transition rate could have an impact on sleep-dependent memory consolidation. These potential biomarkers could help diagnose type 1 narcolepsy in children more quickly; however, further studies with larger cohorts, including of those with type 2 narcolepsy and hypersomnia, are needed.

Clinical Evaluation and Management of Narcolepsy in Children and Adolescents

While sleepiness is common among children, and particularly adolescents, profound sleepiness in the setting of apparently adequate sleep should prompt consideration of a central disorder of hypersomnolence. These disorders, which include narcolepsy, idiopathic hypersomnia, Kleine-Levin syndrome, and others, are likely underrecognized in the pediatric population. Narcolepsy in particular should be of interest to child neurologists as the unique signs and symptoms of this disease often prompt evaluation in pediatric neurology clinics. While sleepiness may appear to be a straightforward complaint, its evaluation requires a nuanced approach. Cataplexy, a hallmark of narcolepsy, can be confused for other neurologic conditions, though understanding its various manifestations makes it readily identifiable. Clinicians should be aware of these symptoms, as delay in diagnosis and misdiagnosis are common in childhood narcolepsy. While treatment options have been limited in the past, many new therapeutic options have become available and can result in significant improvement in symptoms. Given the age at presentation, paroxysmal and chronic features, diagnostic modalities, and available treatment options, the field of child neurology is well equipped to see patients with narcolepsy. In this review, I will focus on the presentation, evaluation, and management of pediatric patients with narcolepsy.

Secondary Narcolepsy in Children.

Secondary narcolepsy occurs as a consequence of lesions involving the hypothalamic region that subserve wakefulness. Although observations on the characteristics of secondary narcolepsy have been published in adults, information on this topic in children is sparse. This is a retrospective study of characteristics and outcome of secondary narcolepsy in children. The medical records of 10 children with this condition at Mayo Clinic, Rochester, were reviewed. Characteristics of the underlying neurologic disorder, narcolepsy subtype, multiple sleep latency tests, medications used and outcome were extracted. Age at diagnosis of narcolepsy was between 6 and 17 years. Five of 10 patients had onset of excessive sleepiness within 1 year of diagnosis of the primary neurologic disorder. Six of 10 patients had type 1 narcolepsy (with cataplexy) whereas 4/10 had type 2 (without cataplexy). The clinical course was variable, with 8/10 continuing to require treatment for sleepiness at a mean period 6.6±6.2 years after diagnosis. One patient with narcolepsy type 1 due to Niemann Pick type C disease had died. One patient with narcolepsy type 2 due to craniopharyngioma had spontaneous remission of sleepiness. The 5/10 patients surviving with narcolepsy type 1 have continued to require pharmacotherapy for both sleepiness and cataplexy. This study draws attention to an important chronic sequel of childhood brain lesions that has variable, etiology-specific outcome. The rare occurrence of spontaneous resolution of childhood narcolepsy symptoms, not previously described, is also discussed.

Reassessment of the risk of narcolepsy in children in England 8 years after receipt of the AS03-adjuvanted H1N1 pandemic vaccine: A case-coverage study.

BackgroundEarly studies of narcolepsy after AS03-adjuvanted pandemic A/H1N12009 vaccine (Pandemrix) could not define the duration of elevated risk post-vaccination nor the risk in children aged under 5 years who may not present until much older.Methods/FindingsClinical information and sleep test results, extracted from hospital notes at 3 large pediatric sleep centers in England between September 2017 and June 2018 for narcolepsy cases aged 4–19 years with symptom onset since January 2009, were reviewed by an expert panel to confirm the diagnosis. Vaccination histories were independently obtained from general practitioners (GPs). The odds of vaccination in narcolepsy cases compared with the age-matched English population was calculated after adjustment for clinical conditions that were indications for vaccination.GP questionnaires were returned for 242 of the 244 children with confirmed narcolepsy. Of these 5 were under 5 years, 118 were 5–11 years, and 119 were 12–19 years old at diagnosis; 39 were vaccinated with Pandemrix before onset. The odds ratio (OR) for onset at any time after vaccination was 1.94 (95% confidence interval [CI] 1.30–2.89), The elevated risk period was restricted to onsets within 12 months of vaccination (OR 6.65 [3.44–12.85]) and was highest within the first 6 months. After one year, ORs were not significantly different from 1 up to 8 years after vaccination. The ORs were similar in under five-year-olds and older ages. The estimated attributable risk was 1 in 34,500 doses. Our study is limited by including cases from only 3 sleep centers, who may differ from cases diagnosed in nonparticipating centers, and by imprecision in defining the centers’ catchment population. The potential for biased recall of onset shortly after vaccination in cases aware of the association cannot be excluded.ConclusionsIn this study, we found that vaccine-attributable cases have onset of narcolepsy within 12 months of Pandemrix vaccination. The attributable risk is higher than previously estimated in England because of identification of vaccine-attributable cases with late diagnoses. Absence of a compensatory drop in risk 1–8 years after vaccination suggests that Pandemrix does not trigger onsets in those in whom narcolepsy would have occurred later.

Narcolepsy in children and young people in Ireland: 2006–2017

To describe the population of young people in Ireland diagnosed with narcolepsy with regards to vaccine exposure, symptomatology, investigation results and experience of medical treatment. Retrospective review of medical records at the single tertiary referral centre for young people with narcolepsy in Ireland. Sixty-seven patients were diagnosed with narcolepsy between July 2006 and July 2017. Sixty-one (91%) of these developed symptoms after receiving the Pandemrix vaccine. The population was largely homogeneous with low hypocretin (87.5%), HLA DQB1∗0602 positivity (95%) and unremarkable findings on MRI Brain (100%). 77.6% experienced cataplexy; we also measured high levels of obesity, school non-attendance and psychosocial complexity. Symptoms often continued despite treatment, with multiple medications prescribed in 76.1% of patients. Prescription of sodium oxybate was associated with a significant reduction in BMI standard deviation scores at 6 months, with improved IOTF obesity scores seen at 36 month follow-up. This paper describes the experience of narcolepsy in children and young people in Ireland from 2006 - 2017at the national tertiary referral centre. Narcolepsy in children and young people in Ireland carries a significant burden of illness, with impact on participation in education as well as physical and mental health. Symptoms can be refractory to medical treatment. Referral to tertiary centres for prompt treatment and multidisciplinary input is essential.

Awareness of Sleep and Narcolepsy in Children

Awareness of Sleep and Narcolepsy in Children

Narcolepsy in Children and Adults: A Guide to Improved Recognition, Diagnosis and Management.

Narcolepsy is a rare condition that affects children and adults, and commonly has an onset in childhood. Time to appropriate diagnosis frequently is at least a decade. Unrecognized or misdiagnosed symptoms of narcolepsy contribute to increased morbidity, disability and socioeconomic liability in these patients. Delays in diagnosis may be related to variability in presentation in childhood, lack of familiarity with symptoms or appropriate diagnostic testing or misdiagnosis with accidental introduction of treatment that may modify or mask narcolepsy features. Improved awareness about the diagnosis and tailored therapies improve clinical and socioeconomic outcomes by reducing time to effective treatment. Application of effective treatment results in long-term benefits by improving clinical outcomes, potentially enabling improved education, increased employment opportunity, and improved work productivity and quality of life. This review provides a comprehensive stepwise approach to improve knowledge and comfort for recognition of symptoms, diagnostic strategies and management considerations of narcolepsy in children and adults.

Narcolepsy and 2009 H1N1 pandemic vaccination in Taiwan

BackgroundSeveral European countries have observed an association between narcolepsy and H1N1 vaccines containing AS03® adjuvant in children/adolescents. In Taiwan, a nationwide campaign starting November 2009 administered H1N1 vaccines without adjuvant or with MF59® adjuvant to 67% of children and 12% of adults. MethodsFor those registered in the 2000–2012 National Health Insurance (NHI) databases, we compared age-stratified (0–4, 5–18, 19–59, and ≥60 years) incidence of first referral for a diagnostic MSLT for the pre-pandemic, pandemic/pre-vaccination, and vaccination/post-pandemic period. We also compared the odds of H1N1 vaccination in each chart-ascertained narcolepsy patient, whoever had an onset of excessive daytime sleepiness between April 2009 and December 2012, with 10 population-based controls from the NHI databases on year of birth, sex, and index date, using conditional logistic regressions. ResultsIncidence of MSLT referral for narcolepsy was highest and significantly increased in the pandemic/pre-vaccination period in the age group 5–18 (IRR 3.40, 95% confidence intervals (CI) 2.12–5.45) and 19–59 (IRR 2.90, 95% CI 1.62–5.02) years. Among 137 confirmed narcolepsy cases (86 adults and 51 children), the odds ratios (ORs) were 1.67 (95% CI 0.81–3.45) (adults) and 1.22 (95% CI 0.62–2.39) (children) for H1N1 vaccination without adjuvant, and 1.39 (95% CI 0.17–11.48) (adults) and 3.66 (95% CI 0.37–36.02) (children) with MF59® adjuvant. ConclusionNo substantial association between the use of H1N1 vaccines and narcolepsy was identified in Taiwan. Instead, the H1N1 infection itself could have played a role in triggering narcolepsy in children and young adults.

Narcolepsy and adjuvanted pandemic influenza A (H1N1) 2009 vaccines – Multi-country assessment

BackgroundIn 2010, a safety signal was detected for narcolepsy following vaccination with Pandemrix, an AS03-adjuvanted monovalent pandemic H1N1 influenza (pH1N1) vaccine. To further assess a possible association and inform policy on future use of adjuvants, we conducted a multi-country study of narcolepsy and adjuvanted pH1N1 vaccines. MethodsWe used electronic health databases to conduct a dynamic retrospective cohort study to assess narcolepsy incidence rates (IR) before and during pH1N1 virus circulation, and after pH1N1 vaccination campaigns in Canada, Denmark, Spain, Sweden, Taiwan, the Netherlands, and the United Kingdom. Using a case-control study design, we evaluated the risk of narcolepsy following AS03- and MF59-adjuvanted pH1N1 vaccines in Argentina, Canada, Spain, Switzerland, Taiwan, and the Netherlands. In the Netherlands, we also conducted a case-coverage study in children born between 2004 and 2009. ResultsNo changes in narcolepsy IRs were observed in any periods in single study sites except Sweden and Taiwan; in Taiwan incidence increased after wild-type pH1N1 virus circulation and in Sweden (a previously identified signaling country), incidence increased after the start of pH1N1 vaccination. No association was observed for Arepanrix-AS03 or Focetria-MF59 adjuvanted pH1N1 vaccines and narcolepsy in children or adults in the case-control study nor for children born between 2004 and 2009 in the Netherlands case-coverage study for Pandemrix-AS03. ConclusionsOther than elevated narcolepsy IRs in the period after vaccination campaigns in Sweden, we did not find an association between AS03- or MF59-adjuvanted pH1N1 vaccines and narcolepsy in children or adults in the sites studied, although power to evaluate the AS03-adjuvanted Pandemrix brand vaccine was limited in our study.

Treatment of paediatric narcolepsy with sodium oxybate: a double-blind, placebo-controlled, randomised-withdrawal multicentre study and open-label investigation

Narcolepsy is a lifelong neurological disorder with onset commonly in childhood or adolescence. No drugs are indicated for cataplexy and excessive daytime sleepiness in paediatric patients with narcolepsy. Sodium oxybate is approved for use in adult patients with excessive daytime sleepiness or cataplexy, or both, in narcolepsy. We aimed to examine the safety and efficacy of sodium oxybate oral solution treatment in children and adolescents who have narcolepsy with cataplexy. This was a prospective, double-blind, placebo-controlled, randomised-withdrawal, multisite study and open-label investigation done at 30 sites in five countries (USA, Finland, France, Italy, and the Netherlands). Eligible participants were aged 7-16 years at screening, had narcolepsy with cataplexy, and were either being treated with sodium oxybate or were sodium oxybate-naive at entry. Sodium oxybate-naive participants were titrated to an optimal dose. Participants were randomly assigned (1:1) with a dynamic randomisation algorithm to receive placebo or to remain on sodium oxybate for 2 weeks; they then entered an open-label sodium oxybate treatment period for a total study duration of up to 1 year. Random assignment to placebo was discontinued if early efficacy was shown in the preplanned interim analysis of the primary efficacy endpoint, which was change in weekly number of cataplexy attacks. Participants entering the study after the interim analysis would then be assigned to receive open-label sodium oxybate for 2 weeks. The primary analysis of efficacy and safety included data collected until the cutoff date of Feb 10, 2017. The efficacy population consisted of all participants randomly assigned to receive an intervention who completed at least 5 days of dosing in the double-blind treatment period, and the safety population consisted of all participants who took the study drug, including open-label sodium oxybate. This study is registered with ClinicalTrials.gov, number NCT02221869. Between Oct 1, 2014, and Feb 10, 2017, we enrolled 106 participants, and 104 took the study drug (the safety population). 96 (92%) of these participants completed the stable-dose period, of whom 63 participants (the efficacy population) were randomly assigned to receive sodium oxybate (n=31) or placebo (n=32) for 2 weeks. A preplanned interim analysis of the primary endpoint showed efficacy (p=0·0002), resulting in discontinuation of the placebo arm following guidance from the data safety monitoring board; 33 participants then received sodium oxybate on an open-label basis during the double-blind period. Participants who were randomly assigned to receive placebo and who were withdrawn from sodium oxybate (32 [51%] of 63 patients) had increased weekly cataplexy attacks (median increase of 12·7 attacks per week [Q1, Q3=3·4, 19·8]) when compared with those randomly assigned to continue treatment with sodium oxybate (median increase of 0·3 attacks per week [-1·0, 2·5]; p<0·0001). Commonly reported (>5%) adverse events were enuresis (15 [21%] of 72 sodium oxybate-naive participants vs four [13%] of 32 participants taking sodium oxybate at study entry), nausea (16 [22%] vs two [6%]), vomiting (15 [21%] vs two [6%]), headache (13 [18%] vs four [13%]), decreased weight (11 [15%] vs one [3%]), decreased appetite (eight [11%] vs none), nasopharyngitis (seven [10%] vs none), and dizziness (five [7%] vs 1 [3%]). Two serious adverse events (one event of severe acute psychosis and one event of moderate suicidal ideation) were reported, and both were considered to be related to the study drug. There were no reported deaths. These results support the clinical efficacy of sodium oxybate for the treatment of both excessive daytime sleepiness and cataplexy in narcolepsy in children. The safety profile of sodium oxybate was consistent with that observed in adult patients. Jazz Pharmaceuticals.

Migraine and risk of narcolepsy in children: A nationwide longitudinal study.

BackgroundThe association between migraine and narcolepsy remains controversial. We aim to investigate whether migraine is associated with an increased risk of developing narcolepsy in children.MethodsIn this longitudinal study, nationwide medical-claims data of pediatric patients (0-17y) with migraine are identified using the National Health Insurance Research Database (NHIRD) between 1997 and 2010 in Taiwan. Two cohorts are selected: migraine cases (n = 8,923) and propensity score-matched non-migraine controls (n = 35,692). Children with previous history of narcolepsy or headache before the index date are excluded. Cohorts are followed until the end of 2012, their withdrawal from the NHI program, or incidence of narcolepsy (ICD-9-CM: 347). Cox proportional hazards regression models are used to estimate hazard ratios (HRs) and 95% confidence intervals of developing narcolepsy in children with migraine compared to their non-migraine controls.ResultsA total of 13 incident cases with narcolepsy are observed during follow-up, with incidence rates of 0.1915 and 0.0278 per 1,000 person-years in migraine and non-migraine children, respectively. After a mean follow-up period of 4.68 and 5.04 years in the case and control cohort, respectively, the former exhibited a greater risk of developing narcolepsy compared to the latter (adjusted hazard ratio (aHR) = 5.30, 95% confidence interval (CI): 1.61, 17.4; p = 0.006). This finding persisted after controlling for potential confounders like baseline comorbidities and concurrent medication uptake, and in our analyses with migraine subtypes.ConclusionsMigraine is an independent risk factor for narcolepsy development in children. Further studies are needed to validate our findings and to explore the exact pathophysiological mechanisms linking migraine and narcolepsy.

Pandemrix\xae vaccination is not associated with increased risk of islet autoimmunity or type 1 diabetes in the TEDDY study children

Aims/hypothesisDuring the A/H1N1 2009 (A/California/04/2009) pandemic, mass vaccination with a squalene-containing vaccine, Pandemrix®, was performed in Sweden and Finland. The vaccination was found to cause narcolepsy in children and young adults with the HLA-DQ 6.2 haplotype. The aim of this study was to investigate if exposure to Pandemrix® similarly increased the risk of islet autoimmunity or type 1 diabetes.MethodsIn The Environmental Determinants of Diabetes in the Young (TEDDY) study, children are followed prospectively for the development of islet autoimmunity and type 1 diabetes. In October 2009, when the mass vaccination began, 3401 children at risk for islet autoimmunity and type 1 diabetes were followed in Sweden and Finland. Vaccinations were recorded and autoantibodies against insulin, GAD65 and insulinoma-associated protein 2 were ascertained quarterly before the age of 4 years and semi-annually thereafter.ResultsBy 5 August 2010, 2413 of the 3401 (71%) children observed as at risk for an islet autoantibody or type 1 diabetes on 1 October 2009 had been vaccinated with Pandemrix®. By 31 July 2016, 232 children had at least one islet autoantibody before 10 years of age, 148 had multiple islet autoantibodies and 96 had developed type 1 diabetes. The risk of islet autoimmunity was not increased among vaccinated children. The HR (95% CI) for the appearance of at least one islet autoantibody was 0.75 (0.55, 1.03), at least two autoantibodies was 0.85 (0.57, 1.26) and type 1 diabetes was 0.67 (0.42, 1.07). In Finland, but not in Sweden, vaccinated children had a lower risk of islet autoimmunity (0.47 [0.29, 0.75]), multiple autoantibodies (0.50 [0.28, 0.90]) and type 1 diabetes (0.38 [0.20, 0.72]) compared with those who did not receive Pandemrix®. The analyses were adjusted for confounding factors.Conclusions/interpretationChildren with an increased genetic risk for type 1 diabetes who received the Pandemrix® vaccine during the A/H1N1 2009 pandemic had no increased risk of islet autoimmunity, multiple islet autoantibodies or type 1 diabetes. In Finland, the vaccine was associated with a reduced risk of islet autoimmunity and type 1 diabetes.

Narcolepsy in a Pre-teen Girl: A Case Report

Background: Narcolepsy is a neurological disorder, the main classic feature of which is excessive day time sleepiness (EDS), with recurrent episodes of irresistible sleep (sleep attacks). It is thought to result from genetic predisposition, abnormal neurotransmitter functioning and sensitivity, and abnormal immune modulation. The onset of narcolepsy symptoms usually starts in late 2nd or 3rd decade of life. Rare cases of narcolepsy have been reported to occur in the first decade of life, even in infants. We are presenting a case of narcolepsy in a 10 years old girl, who presented at Livingstone Central Hospital. This case has been presented due to rarity of this condition in this age group. To the best of our knowledge, this is the first documented case of narcolepsy in a pre-teenaged child in Zambia.Objective: To familiarize the health workers about narcolepsy and diagnostic challenges it pose in resource poor Zambian health settings.Case History: A10 years old girl was brought to the pediatrics department of Livingstone Central Hospital by her mother with complaints of having episodes of EDS for the past three years. The onset was insidious and episodes had increased in frequency in past 3 years. She used to sleep while in the class, during talking and sometimes during eating. There was no history of having cataplexy, hallucinations or sleep paralysis. Clinical diagnosis of narcolepsy without cataplexy was made and she was treated with oral fluoxetine and modafanil. She was discharged after staying in the hospital for 6 days. At her follow up after 3weeks, the patient had responded well to treatment and was free of those episodes of day time sleepiness. Currently the patient is doing fine and still on the same treatment.Her FBC, DLC, ESR, LFTs, Urine routine &amp; microscopy, HIV test, all came out normal. She was weighing 43 Kg and was 1.43m tall. Her CT scan of brain didn't show any abnormality. Her physical &amp; neurological examinations were unremarkable.Conclusion: Narcolepsy in children is a rare condition but once it presents, it poses diagnostic challenges in Zambia due to unavailability of sleep laboratories and lack of knowledge among health workers about this disorder.

Narcolepsy in a Pre-teen Girl: A Case Report

Background: Narcolepsy is a neurological disorder, the main classic feature of which is excessive day time sleepiness (EDS), with recurrent episodes of irresistible sleep (sleep attacks). It is thought to result from genetic predisposition, abnormal neurotransmitter functioning and sensitivity, and abnormal immune modulation. The onset of narcolepsy symptoms usually starts in late 2nd or 3rd decade of life. Rare cases of narcolepsy have been reported to occur in the first decade of life, even in infants. We are presenting a case of narcolepsy in a 10 years old girl, who presented at Livingstone Central Hospital. This case has been presented due to rarity of this condition in this age group. To the best of our knowledge, this is the first documented case of narcolepsy in a pre-teenaged child in Zambia.&#x0D; Objective: To familiarize the health workers about narcolepsy and diagnostic challenges it pose in resource poor Zambian health settings.&#x0D; Case History: A 10 years old girl was brought to the pediatrics department of Livingstone Central Hospital by her mother with complaints of having episodes of EDS for the past three years. The onset was insidious and episodes had increased in frequency in past 3 years. She used to sleep while in the class, during talking and sometimes during eating. There was no history of having cataplexy, hallucinations or sleep paralysis. Clinical diagnosis of narcolepsy without cataplexy was made and she was treated with oral fluoxetine and modafanil. She was discharged after staying in the hospital for 6 days. At her follow up after 3weeks, the patient had responded well to treatment and was free of those episodes of day time sleepiness. Currently the patient is doing fine and still on the same treatment. Her FBC, DLC, ESR, LFTs, Urine routine &amp; microscopy, HIV test, all came out normal. She was weighing 43 Kg and was 1.43m tall. Her CT scan of brain didn’t show any abnormality. Her physical &amp; neurological examinations were unremarkable.&#x0D; Conclusion: Narcolepsy in children is a rare condition but once it presents, it poses diagnostic challenges in Zambia due to unavailability of sleep laboratories and lack of knowledge among health workers about this disorder.

Narcolepsy in children: A severity of the disease does not differ from adults

Narcolepsy in children: A severity of the disease does not differ from adults

0949 RETROSPECTIVE MULTIPLE SLEEP LATENCY TEST DATA REVIEW OF SLEEP PATTERNS COMPARING DIFFERENT AGE GROUPS IN CHILDREN DIAGNOSED WITH NARCOLEPSY

Little is known about diagnosing narcolepsy in children. Few studies have looked into the sleep architecture for this population. The current study aims to investigate sleep patterns in individuals who have undergone a Multiple Sleep Latency Test (MSLT) in order to identify common sleep patterns and trends in children diagnosed with narcolepsy. The current study is a retrospective chart review. Children between the age 6 to 21 years of age who have a confirmed diagnosis of narcolepsy as determined by clinical symptoms and a MSLT between 2005 to 2016. Data collected were analyzed with the statistical software SPSS. Different age groups and MSLT values were analyzed using descriptive and nonparametric statistics. In total, there were 66 patient records that were included for data analysis. Out of those, 31(47%) were male. Age was broken up into 3 groups (6–10 years; 11–15 years; and 16–21 years). Average age of participants was 12.9 years. When analyzing MSLT variables, it was found that narcolepsy patients in the older age group (16–21 years of age) were found to have longer sleep onset latency (SOL) time on all 5 of the naps provided when compared to the 6–10 year old group and 11–15 year old group. Mean SOL for the 16–21 age group was 5.02 minutes while it was 2.78 and 2.54 minutes for the 6–10 age group and 11–15 age group respectively. There were no differences in sleep onset REM between age groups. This study found that while each individual enrolled in the study met the diagnostic criteria for narcolepsy, there seems to be individual differences when comparing age groups. Future studies should analyze potential factors that could contribute to these differences of sleep architecture between age groups. N/A

An under-recognized case of childhood narcolepsy with cataplexy

Narcolepsy is a type of dyssomnia characterized by excessive daytime sleepiness, cataplexy, sleep paralysis, and hypnagogic hallucinations. The signs of narcolepsy usually begin during the teenage years and it persists throughout the lifetime. Diagnosing narcolepsy in children can be challenging and the disorder can remain undiagnosed until adulthood. We describe here a case of childhood narcolepsy with cataplexy who was not diagnosed accurately during several admissions. The patient’s signs were initially related to conversion disorder and she took inappropriate medications. However, after a polysomnography, the diagnosis of narcolepsy was established and she was treated appropriately with stimulant medications.

Morbidity of childhood onset narcolepsy: a controlled national study

Narcolepsy is associated with significant morbidities. We evaluated the morbidities and mortality in a national group of child and adolescent patients after a first diagnosis of narcolepsy. MethodsIdentified from the Danish National Patient Registry (NPR), 243 patients (128 boys) aged 0–19 years diagnosed with narcolepsy between 1998 and 2012 with follow-up until 2014 were compared with 970 controls who were randomly chosen from the Danish Civil Registration System Statistics and matched by age, gender and geography. Comorbidities were calculated three years before and after diagnoses. ResultsIn addition to the more frequent health contacts due to neurological diseases, patients showed elevated odds ratios before and after diagnosis of endocrine and metabolic conditions (4.4 (95% CI, 1.9–10.4); 3.8 (1.7–8.4)), nervous disorders (16.6 (8.0–34.4); 198 (49.0–804)), psychiatric illnesses (4.5 (2.3–9.1)/5.8 (2.8–12.1)), pulmonary diseases, and other diseases (3.1 (2.0–4.9); 3.1 (2.0–4.9)). Congenital abnormalities (2.5 (1.1–5.5)), respiratory (2.9 (1.5-5-5)) and eye (5.7 (2.2–15.0)) diseases were more common before diagnosis. Injuries were also more common after diagnosis (1.5 (1.0–2.1)). Narcoleptic children presented significantly more diagnoses of multiple comorbidities than controls before and after diagnosis. ConclusionBefore and after a diagnosis of narcolepsy in children, morbidity is more frequent in several domains, including metabolic, psychiatric, neurological and other diseases.

Narcolepsy in Adolescents: A Review and Three Case Reports

Background: Narcolepsy is a chronic neurological disorder characterized by excessive daytime sleepiness, cataplexy, hypnagogic and/or hypnopompic hallucinations, and sleep paralysis. Due to symptom overlap and comorbidity between narcolepsy and other psychiatric disorders, narcolepsy in children and adolescents can be easily misdiagnosed. Diagnostic delay is common. Method: We review the clinical presentations, epidemiology, etiology, diagnostic criteria, and treatment of this disabling disorder. We also present three examples of cases initially diagnosed as either a medical or psychiatric disorder, leading to a delay in management ranging from seven months to seven years. Discussion: These cases highlight the importance for psychiatrists and other mental health professionals who work with adolescents to become familiar with this uncommon disorder to shorten time to treatment of this patient population. Keywords: Narcolepsy, narcolepsy misdiagnosis, narcolepsy with cataplexy, narcolepsy without cataplexy.