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Sleep
Table 1: Diagnostic Criteria for Narcolepsy
Patients with narcolepsy may be at a higher risk for traffic accidents.
Despite the fact that this has been legally addressed in several countries,
Narcolepsy with cataplexy
there are only a few studies addressing traffic concerns regarding
• Excessive daytime sleepiness
narcolepsy. Historical cross-sectional studies suggest a higher occurrence
• Definite history of cataplexy
of traffic accidents,
25–27
but there are no formal studies showing the
• MSLT optional but advised
absolute risk for these patients. There are no prospective studies
• Hypersomnia not better explained by another disorder
evaluating the effect of risk during medication. Awareness should be
Narcolepsy without cataplexy
raised regarding the potential risk for traffic accidents in unmedicated
• Excessive daytime sleepiness
• Typical cataplexy is not present
patients, but there is a need for further studies in this area, including the
• Abnormal MSLT required
potential effect of treatment.
• Hypersomnia not better explained by another disorder
Narcolepsy due to medical condition
However, in most patients the disease is not correctly identified
• Excessive daytime sleepiness or diagnosed. For example, when applying prevalence ciphers to
• Definite history of cataplexy, abnormal MSLT, or low CSF hypocretin-1 levels
Denmark, approximately 2,500–3,000 patients should be identified, but
• Underlying medical or neurological disorder accounts for daytime sleepiness
fewer than 500 patients were diagnosed with narcolepsy in the period
• Hypersomnia not better explained by another disorder
between 1997 and 2006. Furthermore, it is surprising that more than
MSLT = Multiple Sleep Latency Test; CSF = cerebrospinal fluid.
two-thirds of these patients are not being formally medically treated or
Source: The International Classification of Sleep Disorders: Diagnostic and Coding Manual,
American Academy of Sleep Medicine, 2005.
controlled, according to the Danish National Registry. It is likely that
similar findings are also present in other western countries. There is little
main problem in interpreting these findings is that not all subjects present information regarding the quality of the evaluation and management of
antigens, and the antigens are found in subjects with a long disease duration, patients in different healthcare systems, as only a few studies have
which may mask a potential relation. Antigens that react against addressed such matters. Furthermore, a diagnosis of narcolepsy is often
hypothalamic neurons are also found in control subjects, and other immune incorrect, and a wide variety of mental and neurological disorders have
systems such as cellular mechanisms may be involved. Further prospective been given before submission to a sleep clinic. Frequently, a significant
studies are needed. delay of several years occurs between the onset of the disease and a
diagnosis of narcolepsy,
28
which suggests a high frequency of missed
Quality of Life and Socioeconomic Impact of Narcolepsy diagnoses. These findings, together with the clinical pattern of the
Patients with narcolepsy are often psychosocially impaired in their work and disease, may explain the long interval between onset of the symptoms
interpersonal relations. Affected patients report significantly lower quality of and a correct diagnosis. Since the symptoms of narcolepsy usually appear
life
16–18
and a higher rate of depression and other psychiatric morbidities.
19–21
during adolescence, this means that most narcoleptic patients are
These effects are comparable to those of other neurological diseases such diagnosed too late to prevent the dramatic impact of the disease on their
as parkinsonism and epilepsy. Patients with narcolepsy present a lower personal and professional development.
educational level, are often unemployed, and have a lower income. The
patients have higher morbidity and more contact with the healthcare system Management of narcolepsy may improve quality of life and social
and, consequently, have elevated direct and indirect costs.
16,22
The and professional contact. Treatment with methylphenidate, modafinil,
unemployment rate of patients with narcolepsy is in the region of two out and potassium oxybate may enhance quality of life,
29–32
but no
of three, an occurrence that is much higher than in control groups.
22
There studies have yet presented evidence for an improvement in education,
are no indications that the families of narcoleptic patients are school grades, work capabilities, socioeconomic function, or driving skills
demographically situated in lower social groups. Neither are there any after treatment. Therefore, there is a significant need for further studies
indications that intelligence is lower nor cognitive function impaired, apart addressing socioeconomic aspects and the consequences of narcolepsy,
from attention and executive functions that can be related to sleepiness.
23,24
including the effects of medical and non-medical treatment modalities. ■
1. Heier MS, Evsiukova T, Vilming S, et al., Sleep, 2007;30:969–73. 12. Black JL III, Silber MH, Krahn LE, et al., Sleep, 2005;28: 427–31. 21. Roth B, Nevsimalova S, Act Nerv Super (Praha), 1977;19
2. Bassetti C, Gugger M, Bischof M, et al., Sleep Med, 2003;4:7–12. 13. Overeem S, Geleijns K, Garssen MP, et al., Neurosci Lett, (Suppl. 2):362–3.
3. Mignot E, Lammers GL, Ripley B, et al., Arch Neurol, 2002;59: 2003;341:13–16. 22. Dodel R, Peter H, Walbert T, et al., Sleep, 2004;27:1123–8.
1553–62. 14. Dauvilliers Y, Carlander B, Rivier F, et al., Ann Neurol, 2004;56: 23. Roy A, Br J Psychiatry, 1976;128:562–5.
4. Longstreth WT Jr, Koepsell TD, Ton TG, et al., Sleep, 2007;30: 905–8. 24. Naumann A, Bellebaum C, Daum I, J Sleep Res, 2006;15:
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6. Dauvilliers Y, Montplaisir J, Molinari N, et al., Neurology, 2001;57: 733–41. 27. Broughton R, Ghanem Q, Hishikawa Y, et al., Can J Neurol Sci,
2029–33. 17. Ervik S, Abdelnoor M, Heier MS, et al., Acta Neurol Scand, 1983;10:100–104.
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10. Knudsen S, Mikkelsen JD, Jennum P, Neuroreport, 2007;18:77–9. 20. Reynolds CF III, Christiansen CL, Taska LS, et al., J Nerv Ment Dis, 1999;22:757–65.
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58 US NEUROLOGY
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