The Diagnosis and Management  of Narcolepsy

Phyllis Zee; Michael Thorpy; James Pagel

The Diagnosis and Management  of Narcolepsy

Moderator:

Phyllis Zee, MD, PhD

Northwestern University

Discussants:

Date: June 6, 2012

Roundtable ID: GM39054

Citation: Med Roundtable Gen Med Ed. ; 1(2): 96 - 103.

Summary:
Dr. Phyllis Zee from the Department of Neurology and Sleep Disorders Center, Northwestern University, Chicago, IL moderated the topic "The Diagnosis and Management of Narcolepsy" with Drs. James Pagel from the Department of Family Medicine, University of Colorado School of Medicine, Sleep Disorders Center of Southern Colorado, Pueblo, CO, and Michael Thorpy from Montefiore Medical Center, and Albert Einstein College of Medicine, Bronx, NY.

The discussion focused primarily on:

1) Diagnostic challenges in narcolepsy

2) other causes for excessive daytime sleepiness such as obstructive sleep apnea, sleep deprivation, insomnia or shift work disorder

3) the complexities associated with recognizing and diagnosing cataplexy

4) narcolepsy and effect on patient quality of life

5) psychiatric disorders and comorbidities

6) sleep studies for diagnosis

7) genetic predispositions

8) available treatments

9) the association between narcolepsy and the H1N1 vaccine in children

10) pharmacologic treatments

11) counseling patients with narcolepsy

12) referrals to sleep specialists.

Med Roundtable Gen Med Ed. 2012;1(2):96–103.

Compounds:
amoxapine, amphetamine, armodafinil, dextroamphetamine, fluoxetine, methylphenidate, modafinil, orexin, sodium oxybate, venlafaxine

Trials:
No trials discussed.

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"Narcolepsy is a disorder that’s interesting because it typically does get missed. Although patients may present with complaints of tiredness and fatigue, very often people don’t think of narcolepsy as being a possible cause."
~Michael Thorpy

"One of the big problems is the rarity of the diagnosis. If you’re talking about a diagnosis of 0.05%, most family physicians or primary care physicians may only see just a few of these patients in their career. So, if a primary care physician thinks that they may have a patient with narcolepsy, they should generally refer … because it’s so rare that it isn’t on their screen.."
~James Pagel

"They’re really the first line in identifying it, though, and I think this is really, really important because they’re the ones who will ask a patient who complains of daytime sleepiness and try to make the diagnosis or at least have a high index of suspicion that it could be narcolepsy."
~Phyllis Zee

Clinical Implications:

Narcolepsy is a rare disorder and therefore there are challenges with diagnosis. Although patients present with tiredness and fatigue many physicians do not associate that with narcolepsy.
Cataplexy is a specific symptom seen in 50% of patients with narcolepsy. It may not develop initially so physicians need to monitor patients for cataplexy.
Primary care physicians should refer patients with narcolepsy to sleep specialists.

The Diagnosis and Management of Narcolepsy

Moderator:

Discussants:

Clinical Implications:

The Diagnosis and Management  of Narcolepsy