(1984) found that narcolepsy was associated with the human leukocyte antigen, HLA-DR. Accumulating evidence has proven that narcolepsy type 1 (previously narcolepsy with cataplexy) is caused by the loss of hypocretin-1 (orexin) neurons in the lateral hypothalamus, but patients with narcolepsy type 2 are found to have normal hypocretin levels, and its etiology remains unknown. One current hypothesis is that narcolepsy is related to the destruction of the specific brain area responsible for sleep and wake function and the loss of hypocretin, a neuropeptide in the brain. Although some studies suggest a higher prevalence in males, narcolepsy affects males and females equally. According to previous reports, the global average is between 20 and 50 per 100,000. The lowest prevalence is reported in Israel (0.23 per 100,000), while the highest is in Japan (160 per 100,000). The reported prevalence of narcolepsy varies in studies from different countries and with different ethnicities. The differences between children and adult population may be crucial in diagnosis and tailoring treatment strategies for pediatric narcolepsy. For example, some children who develop cataplexy later may be diagnosed as having narcolepsy without cataplexy initially. In addition, the symptoms of each narcoleptic patient can change between different life stages.
Abbreviation: CSF: cerebral spinal fluid, MSLT: multiple sleep latency test, SOREMP: sleep onset rapid eye movement period.Īlthough diagnostic criteria in ICSD-3 outlined the common symptoms and signs of narcolepsy, several differences in presentation have been noted between adult and pediatric narcolepsy patients. If the CSF Hcrt-1 concentration is tested at a later stage and found to be either ≤110 pg/mL or <1/3 of mean values obtained in normal subjects with the same as-say, then the disorder should be reclassified as narcolepsy type 1. If cataplexy develops later, then the disorder should be reclassified as narcolepsy type 1.
( b) Diagnostic criteria of narcolepsy type 2 according to International Classification of Sleep Disorders 3rd ed. Abbreviation: CSF: cerebral spinal fluid, MSLT: multiple sleep latency test, SOREMP: sleep onset rapid eye movement period. In young children, narcolepsy may sometimes present as excessively long night sleep or as resumption of previously dis-continued daytime napping. ( a) Diagnostic criteria of narcolepsy type 1 according to International Classification of Sleep Disorders 3rd ed. Other forms of management such as psychosocial interventions involve close cooperation between children, school, family, medical personnel, and can further assist their adjustment. Pharmacological treatment including some promising newly-developed medication can decrease cataplexy and daytime sleepiness in children with narcolepsy. In this article, we review pediatric narcolepsy and its treatment approach: medication, behavioral modification, and education/mental support. The treatment of pediatric narcolepsy should be comprehensive. Moreover, there are differences in clinical experiences between Asian and Western population. Therefore, early diagnosis and intervention are essential for children’s development. These symptoms impaired children’s function and negatively influenced their social interaction, studying, quality of life, and may further lead to emotional and behavioral problems. In addition, rapid-eye-movement-related phenomena such as sleep paralysis, sleep terror, and hypnagogic or hypnapompic hallucinations can also occur. Symptoms of pediatric narcolepsy include excessive sleepiness and cataplexy. This review article examined the literature for research reporting on the effects of treatment of pediatric narcolepsy, as well as proposed etiology and diagnostic tools. Its symptoms frequently begin in childhood. Pediatric narcolepsy is a chronic sleep-wakefulness disorder.
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