Which clinical history findings are characteristic of narcolepsy in young children?

Updated: Sep 04, 2019
  • Author: Sagarika Nallu, MD; Chief Editor: Selim R Benbadis, MD  more...
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Answer

The classic picture of narcolepsy may be somewhat different in young children. Children may deny EDS because of embarrassment. In some cases, restlessness and motor overactivity predominate. Academic deterioration, inattentiveness, and emotional lability are common.

At disease onset, children with narcolepsy and cataplexy may display a wide range of motor disturbances that do not meet the classic definition of cataplexy. These motor disturbances, which may be negative (hypotonia) or active (eg, perioral movements, dyskinetic-dystonic movements, or stereotypic movements), may resolve later in the course of the disorder. [4]

In a study of 51 prepubertal patients with narcolepsy, the initial complaints, as well as the typical misdiagnoses, varied by age. [46] Children younger than 5 years presented with unexplained falls and “drop attacks,” aggressive behavior, sudden irritability, and abrupt dropping of objects. Atonic seizures were the most common misdiagnosis in this age group.

In children aged 5-10 years, the most common initial complaint was inattentiveness, followed by repetitive sleepiness and then by difficulty with morning arousal associated with aggressive behavior and abrupt falls in school. [46] These children often were misdiagnosed as having attention deficit hyperactivity disorder (ADHD), learning disability, depression, or another neurologic disorder.

In children aged 10-12 years, poor academic performance was a common complaint. [46] Other presenting symptoms included inappropriate low level of alertness, falling asleep in class, and inability to wake up in the morning.


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