A CLINICAL PICTURE OF CHILD AND ADOLESCENT NARCOLEPSY

Although narcolepsy is rarely diagnosed before adulthood, symptoms oft en begin much earlier and can easily mimic psychiatric disorders in ch ildren and adolescents. Clinical experience from a pediatric sleep cen ter is reviewed in 16 consecutive cases of polysomnographically proven narcolepsy with onset of symptoms by age 13 years. Only 1 of the 16 p atients presented with the classic clinical tetrad of symptoms (sleepi ness, cataplexy, hypnagogic hallucinations, and sleep paralysis). Beha vioral and emotional disturbances were present in 12 of 16 cases, with four patients appearing to have been misdiagnosed with a psychiatric disorder before recognition of the narcolepsy. Obesity appeared as an unexpected association in this case series, with 11 of the 16 narcolep tic patients found to be overweight at the time of diagnosis. The vari ed clinical presentations, polysomnographic findings, family history, and associated psychiatric symptoms are described. The importance of c onsidering narcolepsy in the differential diagnosis of any child or ad olescent with excessive sleepiness is emphasized.