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Narcolepsy. Signs, symptoms,
differential diagnosis, and management
Green PM, Stillman MJ
Kalamazoo Neurology, Mich., USA.
Arch Fam Med 1998 Sep-Oct; 7(5):472-8
ABSTRACT
Narcolepsy is a chronic neurologic disorder
characterized by excessive daytime sleepiness and cataplexy and less often
by hypnagogic hallucinations and sleep paralysis. While patients report
excessive daytime sleepiness and cataplexy as the more frequent symptoms of
this condition, excessive daytime sleepiness is generally believed to be the
most debilitating. Narcolepsy often is undiagnosed or misdiagnosed for a
variety of reasons. Although confirmation of an initial diagnosis requires
monitoring of physiologic variables conducted at a sleep center by
specialists, the primary care physician has a critical role in the
identification and management of this incurable affliction. This article
provides recommendations for the diagnosis and management of narcolepsy.
The
cataplexy associated with narcolepsy can be managed with tricyclic
antidepressants. The excessive sleepiness is managed with stimulants but
newer agents, such as modafinil, which will be marketed as Provigil, and
selegiline hydrochloride, with fewer adverse effects and less abuse
potential, may offer means of promoting daytime wakefulness. Groups such as
the National Sleep Foundation, Washington, DC, and the Narcolepsy Network,
Cincinnati, Ohio, can provide patients with needed support and information.
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