Posted by Craig on April 05, 2002 at 13:40:49:In Reply to: would you classify this as narcolepsy posted by karel on July 31, 2001 at 07:24:59:
Hopefully, lae responses will have some value.
The "whole body shutting down" for "months" does not sound consistant with cateplexy. Usually cateplexic events are seconds to about thiry minutes. The "months" duration make me concerned that there is actually another process going on.
The first concern, and expecially with the episodic response to imipramine, is that the patient has an underlying mood disorder. These "shutting down" events can be vegitative episodes of depression. Since the patient has cycling of the episodes, she may have a baseline bipolar or cyclothalmic disorder.
The second concern would be a recurrent sleep disorder such as recurrent hypersomnia (such as Kleine-Levine syndrome). It would be helpful to know if she had hyperphagia or hypersecuality with theses episodes. These patients would also have MSLT mean sleep latencies that are low (and may even have on or more SOREM). Another feature of these patients is that they will commonly have low SWS.
Know I cannot rule out a narcoleptic with treatment. Commonly narcoleptics who get medicines for EDS, will have improved vigilence, but still low mean sleep latencies on MSLT. (Usually the improvement can be better seen on comparative MWTs.)
However, with my concerns about a mood disorder (especially a cyclic type) or a recurrent hypersonmia. I would think of two options:
1. Discontinue her current medications and do formal testing. "Risk of exacerbation"....well narcolepsy is not a fatal disease.
2. Trial of lithium and then try to taper her previous medications.I would be concerned of the hepatic risks involved with maintaining the patient on the Cylert, since I have considerable doubts about her diagnosis. Also lithium is still REM suppressing, so may still help with her symptoms if I am wrong.
Remember to warn the patient about EDS and safety if any medication changes are made. You may wish to refer the patient for formal psychiatic evaluation.
Late...but hopefully helpful.