Sleep Medicine by Darren R Mansfield

Author:Darren R Mansfield [Mansfield, Darren R]
Language: eng
Format: azw3
Publisher: IP Communications
Published: 2017-05-14T04:00:00+00:00

DIFFERENTIAL DIAGNOSIS

Clearly, narcolepsy needs to be differentiated from other hypersomnolence disorders. Narcolepsy may also occur as a consequence of another medical disorder (such as rare episodes of hypothalamic involvement by granulomatous, infectious, or cancerous disorders): clinical features, appropriate imaging, and other investigations will clarify these aetiologies. Behaviourally induced insufficient sleep syndrome, shift work sleep disorder, and sleep disordered breathing may on occasions produce symptoms and test results suggestive of a narcolepsy diagnosis. Usually a careful history, specific PSG findings, and paying detailed attention to the pre-test recommendations for MSLT will clarify these conditions from narcolepsy.

Depression and other mental health disorders may be comorbid, but also occasionally have to be distinguished from narcolepsy, and the objective measure of sleepiness (MSLT) usually suffices. Occasionally, a cataplexy-like presentation can be a manifestation of a conversion disorder, but again the MSLT, if performed, will not be typical for narcolepsy, and if the opportunity presents, the clinician can document the preservation of deep tendon reflexes during a ‘cataplexy’ episode. Malingering individuals may present with stories suggestive of narcolepsy features as part of a pattern of drug-seeking behaviours, but their efforts will not usually withstand the rigor of careful and full history elicitation and objective testing.

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