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Narcolepsy

Description

An in-depth report on the causes, diagnosis, and treatment of narcolepsy.

Prognosis

Narcolepsy is a life-long problem but it is not progressive. Symptoms may even lessen over time but they never completely disappear. In a 2001 study comparing older adults (over 65 years old) and younger adults, the older group had less cataplexy although there was no difference in excessive daytime sleepiness. In fact, another study suggested that sleep disturbances at night often worsen as a person ages.

Risk for Accidents

Perhaps the most serious consequence of narcolepsy is the high risk for accidents. Almost 75% of patients with narcolepsy reported falling asleep while driving in one survey and 56% reported near accidents. Other common narcolepsy-related accidents include burns from touching hot objects, cuts from sharp objects, and breaking things.

Effects on Mental Functioning

Some, but not all, studies report that people with narcolepsy have problems with memory and attention. Some research suggests that problems may be due to the abnormalities in the brain that cause the narcolepsy itself. Problems in thinking, however, are more likely to be due to tiredness and episodes of sleepiness. One study found that patients with narcolepsy had trouble with short-term memory, although if given time to repeat memory tasks their response became normal.

Emotional and Social Difficulties

The patient suffers emotional and social difficulties from the uncontrollable sleep episodes and cataplexy. Studies have reported rates of depression in people with narcolepsy ranging from 30 - 57%. (In the general population, prevalence of depression is 8%.) Studies have shown severe emotional and social dysfunction in all areas, including work, relationships, and leisure activities. One study reported that 25% of men with narcolepsy suffered sexual problems. Some experts believe that the psychological and social effects are more serious than those caused by epilepsy (which narcolepsy can be mistaken for).

Accompanying Physical Problems

Headaches. Studies report a very high incidence of headaches in general, and migraines in particular. In one study, 81% of narcolepsy patients had headaches, with 57% of them reporting migraines. In another study, migraines were reported in 44% of women and 28% of men with narcolepsy. Narcolepsy developed more than a decade before the migraines did, suggesting some common disease pathway in both disorders.

Obesity. Evidence suggests that people with narcolepsy are at high risk for obesity compared to the general population. This could be a consequence of low activity level, but research also indicates that deficiencies in the brain peptide hypocretin may play a role in both narcolepsy and feeding behavior, which could increase the risk for obesity.

• Review Date: 7/13/2006
• Reviewed By: Harvey Simon, M.D., Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital

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