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Perhaps as many as 5% of adults are excessively sleepy to a clinically relevant extent.1 The comparable figure for children is not known, but sleepiness is associated with many different conditions and, although a neglected topic, it can be the cause of serious psychological and social disadvantage.2Narcolepsy is by no means the most common cause of excessive sleepiness. Nonetheless, it is not the rarity once supposed, and poses special problems of recognition and management, especially in young people. The purpose of this article is mainly to review the clinical picture of narcolepsy in children and adolescents, emphasising the need for paediatricians, child psychiatrists, and others to take a wide view of the ways in which the condition can show itself. The clinical picture is often very different from that of the fully developed narcolepsy syndrome in adults. It is, therefore, at particular risk of either being overlooked or misconstrued.
Narcolepsy in general
Narcolepsy is a neurological disorder, the main classic feature of which is excessive sleepiness during the day, with recurrent episodes of irresistible sleep (sleep attacks). In its fully developed form the “narcolepsy syndrome” also includes sudden loss of muscle tone in response to strong emotion (cataplexy), vivid dream-like experiences before falling asleep (hypnagogic hallucinations) or on waking (hypnopompic hallucinations), and episodes of inability to move after waking in the morning (sleep paralysis). Estimates for the occurrence of the non-sleepiness (“ancillary”) components of the syndrome are: cataplexy (all cases where cataplexy is required for the diagnosis of narcolepsy; however, others accept that in about 20% of cases cataplexy is not present), hypnagogic or hypnopompic hallucinations (50–60%), and sleep paralysis (40%). These symptoms occur in various combinations and less than half of those with narcolepsy develop all four of them. In narcolepsy, overnight sleep is generally disrupted, causing some degree …
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