60. Narcolepsy
Definition
A neurologic disorder, narcolepsy is a derangement of the normal sleep-wake cycle characterized by episodes of excessive daytime sleepiness (EDS), cataplexy, hypnagogic and/or hypnopompic hallucinations, and sleep paralysis, all of which represent inappropriate intrusions of sleep into the awake state. Onset of this disorder may be at any time, from as young as 10 years of age through the fifth decade. There is no known cure at the present time.
Incidence
Narcolepsy is found worldwide without regard to race or ethnic group. Some groups appear to be more prone to develop narcolepsy; in Japan the estimated incidence is 1:600, in the United States the estimated prevalence ranges from 1:1000 to 1:10,000, and in Israel the estimated prevalence is 1:500,000. The estimated prevalence rates for the United States, alone, may account for 10,000 to 20,000 to as many as 100,000 to 200,000 patients.
Etiology
The cause of narcolepsy has not been delineated. The disease does seem to appear in families.
Signs and Symptoms
The classic symptoms of narcolepsy include EDS, cataplexy, sleep paralysis, and hypnogogic or hypnopompic hallucinations, which are referred to as the “narcolepsy tetrad.” When a patient reports EDS that is accompanied by one of the other three parts of the tetrad, the diagnosis of narcolepsy is highly suspected. Only 20% to 25% of patients with narcolepsy display all four parts of the tetrad.