Narcolepsy pp 55-67 | Cite as

Narcolepsy in Childhood

  • Suresh Kotagal
  • Shalini Paruthi


Establishing a diagnosis of narcolepsy can be challenging in children, given the non-specific initial symptoms, limited descriptive ability of the child, and variability in reliability of the parents as historians. In the pre-school-age child, it may be hard to distinguish physiologic napping from pathologic sleepiness. In school age children, the combination of inattentiveness, trouble sleeping at night, sleepiness, and hypnagogic hallucinations can be mistaken for depression, emphasizing the need for a thorough history. Sleep logs, nocturnal polysomnography, the multiple sleep latency test (that sometimes needs to be repeated serially over months when the diagnosis is uncertain), and cerebrospinal fluid hypocretin analysis are key diagnostic studies. Management strategies include regularizing sleep–wake schedules, taking planned daytime naps to dissipate sleepiness, and exercising regularly. Parents should monitor the child closely for symptoms of depression. Counseling for emotional support is also suggested. Pharmacotherapy should target the symptom(s) most bothersome to the child. Drug treatment of daytime sleepiness, cataplexy, sleep fragmentation, and comorbid depression is with agents that are used on an “off-label” basis and are, at best, only modestly effective.


Childhood Narcolepsy–cataplexy Hypnagogic hallucinations Hypnopompic hallucinations Sleep paralysis Excessive daytime sleepiness Hypocretin-1 Multiple sleep latency test Sodium oxybate Modafinil 


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Authors and Affiliations

  • Suresh Kotagal
    • 1
  • Shalini Paruthi
    • 2
  1. 1.Department of Neurology and the Center for Sleep MedicineMayo ClinicRochesterUSA
  2. 2.Sleep Disorders CenterUniversity of Michigan Medical CenterAnn ArborUSA

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