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Childhood narcolepsy mimicking epileptic seizures: case report
Narcolepsy type 1 is a chronic neurologic disorder defined by excessive daytime sleepiness, cataplexy, sleep paralysis, hallucinations and disrupted nocturnal sleep, typically with onset during childhood/adolescence. The peculiar presentation of symptoms in narcoleptic children could in part explain the misdiagnosis. Hypotonia and the complex hyperkinetic movements that characterize cataplexy close to the onset could be misdiagnosed as a movement disorder or as other neurologic conditions, as epileptic seizures with consequent therapeutic delay. In healthy children without history of epileptic seizures, incidence of abnormalities in EEG was 2–4%.
To report a case of a 8-years-old narcoleptic patient misdiagnosed with epilepsy.
The following report was made through retrospective analysis of the patient's medical records and interviews with the patient and her mother. Review of the literature about the subject was conducted.
The patient is a female who, at 8 years-old, began having excessive daytime sleepiness, with recent increase of total sleep time from 9 hours to 14 hours a day, due to increase of daytime sleep, mantaining the same patern of sleep at night. She also started presenting sudden episodes of loss of strength in the whole body without losing conciousness, and episodes of ptosis and mumbled speech, which lasted seconds to a few minutes with no identifiable triggering factors at the time. Patient reported weight gain, impairment in the social and school performance due to the symptoms. Few months later she was diagnosed with anemia, without response to its clinical treatment. About a year later, she kept hypersomnia symptoms and was submited to an eletroencephalogram, which evidenced epileptform discharge. At the time, it was introduced Carbamazepine, titled up to 600mg/day with no improvement of the symptoms. She was then refered to a sleep practioner, perfomed a polysomnograhy with a latency time to NREM sleep of 2,8min. No MLST was conducted at the time because of the patient's age. Catapletic symptoms became clearer and she was diagnosed with type-1 Narcolepsy due the clinical symptoms.It was introduced Sertraline 50mg a day and methylphenidate with improvement of the symptoms.
In this case report, cataplexy was mistaken as epileptic seizure, which was reinforced by the exam finding in one EEG, which might have no significant repercussion. In children, cataplexy is more difficult to identify due to its particularities.
type-1 narcolepsy, epilepsy
Relato de Caso
Instituto da Criança do HCFMUSP - Sao Paulo - Brasil
Bruno Sérgio Vasconcellos, Mariana Delgado Fernandes, Cássio Batista Lacerda, Ila Marques Porto Linares, Marcela Yanagimori, Andrea Cecilia Toscanini, Daniel Guilherme Susuki Borges, Clarissa Bueno, Leticia Santoro Azevedo Soster