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Narcolepsy

Regularly Assess for EDS and Cataplexy in All Patients With Narcolepsy^1-3

Hailey Atkinson, MSN, FNP-BC

EDS may vary over time in patients with narcolepsy^4-6 and may manifest in different ways^7,8

Inability to stay awake and alert throughout the day⁷
Lapses in concentration^7,8
Patients may describe as “tiredness” or “fatigue”⁸
Constant need for sleep⁷
Unintended lapses into drowsiness or sleep⁷
Automatic behaviors associated with microsleep episodes (eg, writing gibberish)^7,9

Cataplexy may develop years after the onset of EDS and may differ widely among patients^7,10

Drooping of the eyelids¹¹
Muscle weakness in the face or neck^7,11
Mouth opening or tongue sticking out¹¹
Facial jerks/grimaces¹¹
Knee buckling³
Patients may describe as “losing muscle control,” “clumsiness,” or loss of grip^2,3,10

Interactive cataplexy tool thumbnail

Assessing for cataplexy in patients with narcolepsy

Use this interactive tool to explore examples of cataplexy.

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References

Krahn LE, Hershner S, Loeding LD, et al. Quality measures for the care of patients with narcolepsy. J Clin Sleep Med. 2015;11(3):335. doi:10.5664/jcsm.4554
Morse AM. Narcolepsy in children and adults: a guide to improved recognition, diagnosis and management. Med Sci (Basel). 2019;7(12):106. doi:10.3390/medsci7120106
Thorpy M, Morse AM. Reducing the clinical and socioeconomic burden of narcolepsy by earlier diagnosis and effective treatment. Sleep Med Clin. 2017;12(1):61-71.
Almeneessier AS, Alballa NS, Alsalman BH, Aleissi S, Olaish AH, BaHammam AS. A 10-year longitudinal observational study of cataplexy in a cohort of narcolepsy type 1 patients. Nat Sci Sleep. 2019;11:231-239.
Büchele F, Baumann CR, Poryazova R, Werth E, Valko PO. Remitting narcolepsy? Longitudinal observations in a hypocretin-deficient cohort. Sleep. 2018;41(9). doi:10.1093/sleep/zsy118
Kim T, Lee JH, Lee CS, Yoon IY. Different fates of excessive daytime sleepiness: survival analysis for remission. Acta Neurol Scand. 2016;134(1):35-41.
American Academy of Sleep Medicine. International Classification of Sleep Disorders. 3rd ed, text revision. American Academy of Sleep Medicine; 2023.
Ahmed IM, Thorpy MJ. Clinical evaluation of the patient with excessive sleepiness. In: Thorpy MJ, Billiard M, eds. Sleepiness: Causes, Consequences and Treatment. Cambridge, UK: Cambridge University Press; 2011:36-49.
Pizza F, Filardi M, Moresco M, et al. Excessive daytime sleepiness in narcolepsy and central nervous system hypersomnias. Sleep Breath. 2020;24(2):605-614.
Bassetti CLA, Adamantidis A, Burdakov D, et al. Narcolepsy - clinical spectrum, aetiopathophysiology, diagnosis and treatment. Nat Rev Neurol. 2019;15(9):519-539.
Pizza F, Antelmi E, Vandi S, et al. The distinguishing motor features of cataplexy: a study from video-recorded attacks. Sleep. 2018;41(5). doi: 10.1093/sleep/zsy026