Rare Case of Late-Onset Narcolepsy Type 1

Kovalská, Petra; Dostálová, Simona; Machová, Hana; Nytrová, Petra; Horvat, Eszter Maurovich; Šonka, Karel

doi:10.1159/000510633

Cited by 3 publications

(4 citation statements)

References 12 publications

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“…A case report describes a 69-year-old male who developed symptoms of narcolepsy type 1. He was subsequently treated with clomipramine for cataplexy and clonazepam for REM sleep behavior disorder and naps to manage daytime sleepiness [12]. Similar to our case, this patient was also positive for obstructive sleep apnea, treated with positive airway pressure.…”

Section: Discussionsupporting

confidence: 71%

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A Rare Presentation of Narcolepsy With Cataplexy After Vaccines in a Genetically Susceptible Elderly Woman: A Case Report

Verma¹,

Prasad²,

Rath³

et al. 2023

Cureus

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Observing cataplexy episodes during an office visit is extremely rare as they are usually triggered by laughter or emotional stress. Narcolepsy usually occurs in the younger population. We report a case of a 65-year-old Caucasian female with a past medical history of obesity who developed excessive daytime sleepiness, fatigue, and sleep attacks five weeks after getting influenza and pneumococcal vaccines. The presentation of cataplexy was atypical. Several episodes of cataplexy were observed during the office visit without any emotional trigger. Further workup, including polysomnography (PSG), was positive for obstructive sleep apnea, controlled with continuous positive airway pressure (CPAP) use. Later, she had PSG with CPAP use, which optimally controlled obstructive sleep apnea, followed by multiple sleep latency tests (MSLT) with CPAP use. It was positive for narcolepsy with a mean sleep latency of 1.6 minutes with sleep onset rapid eye movement (REM) in five out of five naps. Her cerebrospinal fluid (CSF) hypocretin level was extremely low at 50 pg/ml, usually seen in narcolepsy with cataplexy. She was also positive for human leukocyte antigen (HLA) DBQ1*06:02. The diagnosis of narcolepsy with cataplexy was made, which improved with medications for narcolepsy.

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Section: Discussionsupporting

confidence: 71%

“…Even after finding mild obstructive sleep apnea and treating it with CPAP in our patient, her narcolepsy symptoms did not improve. The prevalence of narcolepsy in the elderly population is exceedingly rare but has been reported in a few cases [12][13][14].…”

Section: Discussionmentioning

confidence: 99%

A Rare Presentation of Narcolepsy With Cataplexy After Vaccines in a Genetically Susceptible Elderly Woman: A Case Report

Verma¹,

Prasad²,

Rath³

et al. 2023

Cureus

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“…However, a comprehensive work-up should be conducted, as effective medication can dramatically improve the patient's quality of life when NT1 is confirmed. Considerable diagnostic delay has been described in such cases, 4 encouraging clinicians to suspect this diagnosis regardless of the patient's age. The present report highlights the importance of the analysis of the level of hypocretin in the CSF in the differential diagnosis of other neurological and sleep disorders.…”

Section: Case Reportmentioning

confidence: 99%

“…Late-onset narcolepsy with cataplexy is rather unusual, although it has been previously described. [2][3][4] The typical clinical picture of NT1 is the association of EDS, cataplexy, hypnagogic and hypnopompic hallucinations, and sleep palsy. The features associated with PSG features are sleep fragmentation, precocious rapid eye movement (REM )onset, and REM behavior disorder.…”

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confidence: 99%

An Unusual Cause of Increasing Excessive Daytime Sleepiness in a CPAP-treated Obstructive Sleep Apnea Patient

Martinet,

Sinkunaite,

Bruyneel

2024

Sleep Sci

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The onset of narcolepsy type 1 (NT1) occurs after 50 years of age in less than 2% of the cases. In older adults, the diagnosis is often delayed due to the presence of neurological degenerative and inflammatory comorbidities and overlapping sleep disorders.We report the case of a 63-year-old man with a 5-year history of excessive daytime sleepiness (EDS) and a 2-year diagnosis of obstructive sleep apnea syndrome (OSAS), which. OSAS was confirmed by respiratory polygraphy that showed an apnea-hypopnea index (AHI) of 71 events/hour of sleep associated with significant nocturnal hypoxemia (lowest oxygen saturation: 53%), which lead to the initiation of continuous positive airway pressure (CPAP) treatment. Cognitive complaints, unexplained spells of dizziness, and lack of improvement in EDS with CPAP led to further diagnostic investigation of infectious, inflammatory, and neurodegenerative disorders. Low hypocretin levels in the cerebrospinal fluid (CSF) confirmed the diagnosis of NT1, and the patient's symptoms improved with the treatment with pitolisant.Though exceptional in older adults, NT1 should be suspected in the presence of atypical EDS with neurological complaints, unexplained dizzy spells, or OSAS that resists the CPAP treatment. Low levels of hypocretin in the CSF are highly specific and rule out other neurological and sleep disorders.

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Management of REM sleep behavior disorder: an American Academy of Sleep Medicine systematic review, meta-analysis, and GRADE assessment

Howell

Avidan

Foldvary‐Schaefer

et al. 2023

Journal of Clinical Sleep Medicine

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Rare Case of Late-Onset Narcolepsy Type 1

Cited by 3 publications

References 12 publications

A Rare Presentation of Narcolepsy With Cataplexy After Vaccines in a Genetically Susceptible Elderly Woman: A Case Report

A Rare Presentation of Narcolepsy With Cataplexy After Vaccines in a Genetically Susceptible Elderly Woman: A Case Report

An Unusual Cause of Increasing Excessive Daytime Sleepiness in a CPAP-treated Obstructive Sleep Apnea Patient

Management of REM sleep behavior disorder: an American Academy of Sleep Medicine systematic review, meta-analysis, and GRADE assessment

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