Which diagnosis best fits duration, episodicity, and exclusions?
A
Narcolepsy
Recurrent periods of irrepressible need to sleep, lapsing into sleep, or napping within same day, for ≥3 months; ≥1 of: cataplexy (brief episodes of bilateral muscle tone loss) ≥few times/month; hypocretin deficiency (CSF hypocretin-1 ≤110 pg/mL); REM sleep latency ≤15 min on MSLT (or mean sleep latency ≤8 min with ≥2 sleep-onset REM periods)
AA. Recurrent periods of irrepressible need to sleep, lapsing into sleep, or napping within same day, for ≥3 months; ≥1 of: cataplexy (brief episodes of bilateral muscle tone loss) ≥few times/month; hypocretin deficiency (CSF hypocretin-1 ≤110 pg/mL); REM sleep latency ≤15 min on MSLT (or mean sleep latency ≤8 min with ≥2 sleep-onset REM periods)
BA. Repeated episodes of arousal during sleep associated with vocalisation and/or complex motor behaviours B. These behaviours arise during REM sleep and therefore occur usually >90 min after sleep onset; are more frequent during the later portions of the sleep period; and uncommonly occur during daytime naps C. Upon awakening from these episodes, the individual is completely awake, alert, and not confused or disoriented
Common specifiers
ANarcolepsy Type 1; Narcolepsy Type 2; Narcolepsy due to another medical condition; Mild
BAcute; Subacute; Chronic; With comorbid neurodegenerative disorder
Differential flags
AHypersomnolence disorder (no cataplexy; normal hypocretin; no MSLT SOREMP pattern); Seizure disorder (cataplexy-like episodes - EEG; no emotional trigger); REM sleep behaviour disorder (acting out dreams, not cataplexy)
BNREM arousal disorders (sleepwalking, sleep terrors - first third of night; amnesia; no dream recall); Obstructive sleep apnoea with arousal behaviours (respiratory events on PSG); Nocturnal seizures (epileptiform activity on EEG)