Narcolepsy
Alerts and Notices
Synopsis
Narcolepsy type 1 affects about 1 in 2000 people. It tends to affect males and females equally. Age of onset is bimodal, at about age 15 and 35. Onset may be observed in school-aged children, but it is most often diagnosed in adolescence or the early 20s.
Other signs and symptoms include irritability, extended night sleep, difficulty waking, inattention, disrupted cognitive function, and mood and behavior dysfunction. Narcolepsy can lead to depression, obesity, and precocious puberty.
The etiology of narcolepsy is not fully understood. However, it is suspected that it is due to an autoimmune process that causes destruction of hypocretin (orexin) neurons in the hypothalamus. There is a strong association between narcolepsy and infection with Streptococcus pyogenes, and there was an increased incidence with the 2009 H1N1 influenza virus and the vaccine. Nearly all patients with type 1 narcolepsy are HLA DQB1*0602 positive compared to 12%-38% in the general population. In some situations, narcolepsy can be due to a medical condition. These include brain tumors, injury to the hypothalamus from cerebral lesions (vascular, sarcoidosis, demyelination) or a paraneoplastic disorder, congenital disorders such as Niemann-Pick disease type C, Parkinson disease, and residual excessive daytime sleepiness in those with adequately treated sleep apnea.
Management of symptoms involves lifestyle changes, good sleep habits, planned naps, and supportive counseling. Pharmacotherapy targets symptomatic relief and requires careful monitoring of undesirable side effects.
Codes
ICD10CM:G47.411 – Narcolepsy with cataplexy
G47.419 – Narcolepsy without cataplexy
SNOMEDCT:
60380001 – Narcolepsy
Look For
Subscription Required
Diagnostic Pearls
Subscription Required
Differential Diagnosis & Pitfalls
- Chronic insufficient sleep syndrome
- Idiopathic hypersomnia / hypersomnolence
- Kleine-Levin syndrome
- Central disorders of hypersomnolence
- Circadian rhythm disorders
- Obstructive sleep apnea
- Restless legs syndrome
- Periodic limb movement disorder
- Depression
- Anemia
- Hypothyroidism
- Substance abuse
- Sedating medications
- Seizures
- Central nervous system tumors
Best Tests
Subscription Required
Management Pearls
Subscription Required
Therapy
Subscription Required
Drug Reaction Data
Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.Subscription Required
References
Subscription Required
Last Reviewed:01/02/2019
Last Updated:09/23/2021
Last Updated:09/23/2021