Narcolepsy: The Daily PANCE Blueprint
A 20-year-old female presents to the clinic complaining of intense sleepiness during the day and also a desire to fall asleep constantly. She has episodes where she feels paralyzed as she is falling asleep. Physical exam is unremarkable. Which of the following is the best diagnostic test to confirm the most likely diagnosis?
A. CT head without contrast
B. Overnight polysomnography
C. Continuous electroencephalogram
D. MRI of the brain
E. Multiple sleep latency test
Answer and topic summary
The answer is E. Multiple sleep latency test
Narcolepsy is a chronic, debilitating sleep disorder characterized by cataplexy, excessive daytime sleepiness (EDS), sleep paralysis, and hypnagogic or hypnopompic hallucinations. It usually begins in the teens or twenties. Referral to a sleep clinic is indicated if narcolepsy is suspected. Typically patients will need to keep a sleep log for 2 weeks and then undergo polysomnography and a multiple sleepy latency test. Multiple sleep latency test is the best diagnostic tool as it observes the quick transition to REM sleep to establish the diagnosis. Treatment includes REM-suppressing antidepressants (e.g., venlafaxine or SSRIs), scheduled day naps, good sleep hygiene, and also modafinil or stimulants like methylphenidate.
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Smarty PANCE Content Blueprint Review:
Covered under ⇒ PANCE Blueprint Psychiatry ⇒ ⇒
