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This chapter presents the clinical history, examination, and the results of the procedures performed on a 30-year-old male shift worker who was admitted for the evaluation of uncontrolled daytime sleepiness and generalized muscle hypotonic attacks. The patient was also falling to the ground without loss of consciousness. The chapter presents the clinical history, examination, follow-up, treatment, diagnosis, and the results of the procedures performed on the patient. The results of polysomnography (PSG) showed that the patient had a total sleep time of 400 minutes and a total wake time of 40 minutes, with a sleep efficiency of 91%. The diagnosis was narcolepsy with cataplexy. Sodium oxybate was administered in increasing doses, and the progression after a year and a half was satisfactory; no episodes of cataplexy occurred during regular work hours. After 4 months of treatment with sodium oxybate, the patient did not complain of daytime sleepiness.
This chapter reviews the clinical and polysomnographic features of elderly narcoleptic subjects, and considers co-morbidity and therapeutic issues. A number of narcoleptic patients are older than 40 at diagnosis, this being due either to mild disease severity or misdiagnosis, or diagnosis delayed until late-life expression of cataplexy, or narcolepsy lacking cataplexy. Knowledge about the co-morbid disorders in narcolepsy is important inasmuch as it may sometimes contribute to diagnosis and it may also bring some insights into the pathophysiology of narcolepsy. Among the most frequently associated diseases were parasomnias, sleep-related breathing disorders, sleep-related movement disorders, internistic diseases, neurological disorders, and psychiatric disorders. Moreover, various drugs, such as stimulants, antidepressants, and sodium oxybate used in narcolepsy have been tested in adult patients over a range of ages, but not specifically in elderly subjects.
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