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Re: SL in narcolepsy on MSLT

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Posted by Craig on March 27, 2002 at 16:00:08:

In Reply to: SL in narcolepsy on MSLT posted by jk621 on March 01, 2002 at 15:14:02:

Acording to the ICSD there are two possible pathways for the diagnosis of narcolepsy:
1. Sleep attacks WITH Cateplexy
2. REM Sleep associated disturbance (HH or SP) with AT LEAST ONE of the classic NPSG or MSLT findings.

So the key question, does the patient have other evidence of REM sleep intrusion (HH or SP)? If yes...he can fit the ICSD Diagnosis of narcolepsy.

If no...commonly when MSLTs are repeated on narcoleptics who have mean sleep latencies of greater than 10 but with more than two SOREM, the mean sleep latency is lower. So repeating the MSLT may be in order to confirm the diagnosis.

But I do have to admit, it is unusual to have FOUR SOREM with a mean sleep latency that indictates only mild sleepiness.

I would therefore do some homework:
1. Re-review the MSLT to ensure that the sleep onset and REM onset were properly scored. (Especially since it may be difficult to differential eyes open from REM in many situations.)
2. Good history of medication usage from the patient and, if an MSLT is repeated, a drug screen? (Remember, drugs NOT being used the night of the study are also important to rule out withdrawal from a REM sleep suppressing medication.)

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