Narcolepsy - Medical Malpractice Lawyers

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Narcolepsy - Medical Malpractice

Narcolepsy is a disease of excessive daytime sleepiness in an otherwise healthy person. You can also get a loss of muscle tone or cataplexy, hypnagogic hallucinations and an inability to move or talk, also called sleep paralysis. A person with narcolepsy can have automatic behaviour when sleeping at night without being aware of their behaviour. Narcolepsy can be mild or very severe.

Narcolepsy begins in the teen years or in a person's twenties. It affects men and women equally. Excessive daytime sleepiness is the main initial symptom and usually gradually develops over time. The other symptoms can take longer to develop.

Narcolepsy is not very common. It affects about 1 in 2000 individuals in the US and Canada but is much rarer in other countries. For example, it occurs at a rate of 1 in 500,000 in Israel but only 1 in 600 in Japan. Not everyone who has narcolepsy gets properly diagnosed.

The cause of narcolepsy is involved with abnormalities of the hypocretin neurons. These cells are noted in the hypothalamus and normally secrete the neurotransmitters called hypocretins. This is responsible for the daytime sleepiness and abnormal REM sleep that you see in narcolepsy.

People with a specific HLA type are more prone to getting narcolepsy than other people. HLA antigens are found on white blood cells, leading to the possibility that autoimmune disease is responsible for the disease of narcolepsy. It is believed that an autoimmune reaction causes a loss of normal nerve cells in the brain in patients who have narcolepsy. The neurotransmitters made by these nerve cells do not occur and the person develops narcolepsy. Narcolepsy is only partly related to heredity but it is not something you see on a regular basis.

The symptoms of narcolepsy include cataplexy or "drop attacks", excessive daytime sleepiness, hypnagogic hallucinations, sleep paralysis, automatic behaviour during sleep, disturbed sleep at night and things like double vision, blurry vision or droopy eyelids. Cataplexy often occurs during extremely emotional times, like laughing, surprise or excitement. In severe attacks, the person completely collapses to the ground and can get injured as a result. The patient is conscious but cannot speak or move. Such attacks can last several seconds or a few minutes. It is present in 75 percent of those who have narcolepsy.

Hypnagogic hallucinations happen in about 50 percent of patients with narcolepsy. These are dreamy experiences that happen in the transition between wakefulness and sleep. You can get hallucinations between sleep and wakefulness called hypnopompic hallucinations. Images are very realistic and it results in the patient feeling as though the hallucination is real or that they are suffering from a mental illness.

About half of all patients with narcolepsy have sleep paralysis. This is a temporary inability to talk or move during sleep to waking transitions or vice versa. They can occur during the time you have hypnagogic hallucinations and can be doubly scary. You are able to breathe but you can't move and it sometimes feels as though you are unable to breathe.

There is also disturbed sleep at night with frequent awakenings and moving around a lot at night. Automatic behaviour is extremely common with people having behaviours that they are completely unaware of.

Narcolepsy is diagnosed by a careful history and physical examination. Sleep logs are used and sleep laboratory evaluations can be done. Questionnaires can be used to determine if a person has symptoms of narcolepsy. Sometimes findings can be noted at the time of a sleep study but daytime narcolepsy is hard to observe on cue. There is a Stanford Narcolepsy Questionnaire that can be used to diagnose the disease.

There are a number of ways to treat narcolepsy, including drug therapy and behavioural therapies. Medications include strong stimulant drugs to keep the person awake during the day. Doctors may have to treat insomnia symptoms and depressive symptoms as they arise. Psychotherapy is used to help a person cope with the symptoms and the effect on their lives.

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The author of the substantive medical writing on this website is Dr. Christine Traxler MD whose biography can be read here