Narcolepsy
Approximation to diagnostic: multiple sleep latency test (MSLT)
Ovidiu C. Banea
�Clinical Neurophysiology Unit
Reykjavík, 09th of December 2016�
Reason
SUMMARY
Basic Knowledge - video open source
Excessive Daytime Sleepiness Scale
Major CNS Hypersomnia Types
International Classification of Sleep Disorder (ICSD - 3) and narcolepsy
Keys for diagnostic
Narcolepsy in Iceland - available internet literature
Sleep Onset REM period SOREMp and Multiple Sleep Latency Test (MSLT)
French Consensus
Conclusions
Basic
knowledge
1:2000
Epworth Scale
Comparison of Major CNS Hypersomnia Types
| Narcolepsy w/Cataplexy | IH with long sleep time | IH without long sleep time | Recurrent Hypersomnia (KLS, Menstrual) |
Symptoms | EDS, SP, HH, cataplexy, fragmented sleep | Nocturnal sleep time > 10h | Nocturnal sleep > 6 h & < 10 h | Excessive sleepiness last 2d – 4 weeks |
Frequency | Almost daily for ≥3 months | Almost daily for ≥3 months | Almost daily for ≥3 months | Recurrence at least once per year |
PSG findings | Short SL and sleep > 10 hours | Short SL and sleep > 10 hours | Sleep > 6 h < 10 h � | - |
MSLT | Mean SL ≤ 8 min and ≥ 2 SOREMPs | Mean SL ≤ 8 min and < 2 SOREMPs | Mean SL ≤ 8 min and < 2 SOREMPs | - |
Types
ICD-3
Keys: pentad (usually ⅗)
-Hypersomnia (Excesive Daytime Sleepiness), most common symptom
-Disrupted (disturbed) sleep (70-80%) sometimes periods of night wakefullness
-Cataplexy (approx 70%) usualy, appears after EDS, few years
-Hypnagogic or Hypnopompic visual, auditory or tactile hallucinations (20-40%)
-Sleep paralysis (25-50%)
Narcolepsy in Iceland
French consensus 2016
New International classification of sleep disorders (ICSD-3) named 2 types
NT1: periods of an irrepressible need to sleep, cataplexy (a sudden loss of muscle tone triggered by emotion) and in some cases the presence of symptoms such as hypnagogic hallucinations, sleep paralysis and disturbed night-time sleep. Loss of hypocretin neurons in the hypothalamus, an auto-immune process.
NT2: cataplexy is absent and the hypocretin levels in the CSF are normal.
Confirming the diagnosis requires polysomnography and multiple sleep latency tests.
The choice of further investigations is based on the presence or absence of typical cataplexy. Further investigations include HLA typing, lumbar puncture to measure the hypocretin level in the CSF, or even brain imagery in the case of narcolepsy suspected to be secondary to an underlying pathology.
French consensus 2016
Monaca et al
2016
Conclusions
Takk fyrir