Interestingly, narcolepsy type 1 is associated with a specific biomarker-low levels of orexin (also known as hypocretin) in the spinal fluid. The patient does not faint, and is conscious throughout the attack, which usually lasts a minute or two. A common report from patients is “my knees sometimes buckle when I laugh.” But it can be more severe, such as falling right down. These patients have EDS as described above along with cataplexy, which is truly one of the most bizarre symptoms in medicine: the sudden loss of muscle tone, triggered by strong emotions, usually positive ones, such as laughing and joking. Narcolepsy with cataplexy (narcolepsy type 1) is the most common type, afflicting 70% of all narcolepsy victims. Other symptoms sometimes seen in narcolepsy include hypnagogic hallucinations (vivid dreamlike images while falling asleep) and sleep paralysis (a temporary inability to move or speak just before falling asleep or just after waking up). ![]() These patients will tell you that they could fall asleep at any point throughout the day, and that they feel better after naps. Also known as narcolepsy type 2, narcolepsy without cataplexy affects 30% of narcoleptics, and the symptoms are primarily profound sleepiness. Narcolepsy, then, is literally “to be seized by sleep”.) (By the way, the Greek etymology of the word narcolepsy comes from narke, which means stupor, and lepsis, or seizure. This sensation of sleepiness must occur most of the time-the official DSM-5 threshold is at 3 days per week for 3 months. Both types include the core feature, which is excessive daytime sleepiness (EDS). (Also see Leschziner G, Pract Neurol 2014 14:323–331 for a comprehensive unbiased review of narcolepsy). It’s probably better for you to get your narcolepsy info here than on Jazz’s supposedly “educational” website. ![]() And partly because Jazz Pharmaceuticals is placing lots of ads in psychiatric journals urging us to diagnose more narcolepsy so that we’ll use their new drug Xyrem. So why are we asking you to read about such a rare disorder? Partly because there’s a lot of comorbidity between narcolepsy and most psychiatric disorders. It’s about as common as Charcot-Marie-Tooth disease, or polycythemia vera, just to put it in perspective. This puts it officially in the category of rare diseases. Narcolepsy affects about 1 out of 2000 people, for a prevalence rate of 0.05%.
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