- Author: Ali M Bozorg, MD; Chief Editor: Selim R Benbadis, MD more...
Narcolepsy is characterized by the classic tetrad of excessive daytime sleepiness (EDS), cataplexy, hypnagogic hallucinations, and sleep paralysis. Narcolepsy is thought to result from genetic predisposition, abnormal neurotransmitter functioning and sensitivity, and abnormal immune modulation.
Signs and symptoms
Manifestations of narcolepsy are as follows:
Cataplexy (brief and sudden loss of muscle tone)
Children rarely manifest all 4 symptoms.
Features of EDS are as follows:
EDS is the primary symptom of narcolepsy
EDS must be present for at least 3 months to justify the diagnosis
Severe EDS leads to involuntary somnolence during activities such as driving, eating, or talking
Sleepiness may be severe and constant, with paroxysms of falling asleep without warning (ie, sleep attacks)
Features of cataplexy are as follows:
If severe and generalized, cataplexy may cause a fall
More subtle forms exist with only partial loss of tone (eg, head nod and knee buckling)
Respiratory and extraocular movements are preserved
Cataplexy is usually triggered by emotions (especially laughter and anger)
Features of sleep paralysis are as follows:
Usually, the patient is unable to move upon awakening
Less commonly, the patient is unable to move upon falling asleep with consciousness intact
Paralysis is often accompanied by hallucinations
Respiratory and extraocular muscles are spared
Paralysis occurs less frequently when the person sleeps in an uncomfortable position
Paralysis can be relieved by sensory stimuli (eg, touching or speaking to the person)
The following are also common features of narcolepsy:
A tendency to take short and refreshing naps during the day; these may be accompanied by dreams
Trouble sleeping at night 
Nocturnal compulsive behaviors (eg, sleep-related eating disorder and nocturnal smoking 
Features of narcolepsy in children are as follows:
Restlessness and motor overactivity may predominate
Academic deterioration, inattentiveness, and emotional lability are common
At disease onset, children with narcolepsy and cataplexy may display a wide range of motor disturbances that do not meet the classic definition of cataplexy
Motor disturbances may be negative (hypotonia) or active (eg, perioral movements, dyskinetic-dystonic, or stereotypic movements)
Motor disturbances may resolve later in the course of the disorder 
See Clinical Presentation for more detail.
Sleep studies are an essential part of the evaluation of patients with possible narcolepsy. The combination of an overnight polysomnogram (PSG) followed by a multiple sleep latency test (MSLT) showing sleep latency ≤8 minutes and 2 or more sleep-onset random eye movement periods (SOREMPs) strongly suggests narcolepsy while excluding other sleep disorders. An alternative criterion is a cerebrospinal fluid hypocretin level of ≤110 pg/mL.
See Workup for more detail.
Nonpharmacologic measures include sleep hygiene, such as the following :
Maintaining a regular sleep schedule, usually 7.5-8 hours of sleep per night
Scheduled naps during the day, in some cases
Pharmacologic treatment of excessive somnolence in narcolepsy includes stimulants such as the following:
Codeine (in patients for whom stimulant treatment is problematic) 
Pharmacologic treatment of cataplexy includes the following:
Sodium oxybate (also treats EDS)
Antidepressants (eg, clomipramine and fluoxetine; off-label use)
Narcolepsy is characterized by the classic tetrad of excessive daytime sleepiness, cataplexy, hypnagogic hallucinations, and sleep paralysis. However, this tetrad is seen only rarely in children.
Narcolepsy frequently is unrecognized, with a typical delay of 10 years between onset and diagnosis. Approximately 50% of adults with the disorder retrospectively report symptoms beginning in their teenage years. This disorder may lead to impairment of social and academic performance in otherwise intellectually normal children. The implications of the disease are often misunderstood by patients, parents, teachers, and health care professionals.
Narcolepsy is treatable. However, a multimodal approach is required for the most favorable outcome.
Diagnostic criteria (DSM-5 and ISCD-3)
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) defines narcolepsy as recurrent episodes of irrepressible need to sleep, lapsing into sleep, or napping occurring within the same day. These must have been occurring at least three times per week over the past 3 months. There also must be the presence of at least one of the following:
Episodes of cataplexy occurring at least a few times per month
REM sleep latency ≤15 minutes, or a mean sleep latency ≤8 minutes and two or more sleep-onset REM periods (SOREMPs)
Narcolepsy can be categorized as mild, moderate, or severe based on the frequency of cataplexy, need for naps, and disturbance of nocturnal sleep. In addition, the DSM-5 identifies five subtypes as follows:
Narcolepsy without cataplexy but with hypocretin deficiency
Narcolepsy with cataplexy but without hypocretin deficiency
Autosomal dominant cerebellar ataxia, deafness, and narcolepsy
Autosomal dominant narcolepsy, obesity, and type 2 diabetes
Narcolepsy secondary to another medical condition
The American Academy of Sleep Medicine's International Classification of Sleep Disorders, Third Edition (ICSD-3) reclassified narcolepsy into two types (narcolepsy type 1 and narcolepsy type 2). In the previous edition of the manual, narcolepsy was categorized as either narcolepsy with cataplexy or narcolepsy without cataplexy. The change in nomenclature reflects the fact that some patients demonstrate hypocretin deficiency (the fundamental cause of narcolepsy), but may not demonstrate cataplexy at the time of diagnosis although they may eventually.
Narcolepsy type 1 is distinguished by sleepiness plus cataplexy and a positive multiple sleep latency test (MSLT), or sleepiness plus hypocretin deficiency. Narcolepsy type 2 requires sleepiness and a positive MSLT and the absence of type-1 markers. And, the hypersomnia and/or MSLT findings must not be better explained by another sleep, neurologic, mental, or medical condition or by medicine or substance use.
Whenever possible, the diagnosis of narcolepsy should be confirmed by polysomnography (PSG) followed by a multiple sleep latency test (MSLT); the MSLT should show sleep latency 8 minutes or less and 2 or more sleep-onset REM periods (SOREMPs). A SOREMP on PSG the night preceding the MSLT may replace one of the SOREMPs on the MSLT. This change in the SOREMP requirement means that clinicians need to pay closer attention to the early stage scoring of night PSGs. An alternative criterion for diagnosis is a CSF hypocretin level of 110 pg/mL or lower.
Narcolepsy is thought to result from genetic predisposition, abnormal neurotransmitter functioning and sensitivity, and abnormal immune modulation. Current data implicate certain human leukocyte antigen (HLA) subtypes and abnormal hypocretin (orexin) neurotransmission, which leads to abnormalities in monoamine and acetylcholine synaptic transmissions, particularly in the pontine reticular activating system.[10, 11]
Understanding of the neurochemistry of narcolepsy began with research involving narcoleptic dogs (eg, special laboratory-bred Dobermans and Labradors). In these animal models, the disorder is transmitted in an autosomal recessive fashion with full penetrance and is characterized mainly by cataplexy. Muscarinic cholinergic stimulation increases cataplexy in these animals, and cholinergic blockade eliminates the symptom. Nicotinic agents have no effect on the cataplexy.
Receptor subtypes such as the alpha1-noradrenergic receptor appear to mediate cataplexy. Prazosin, an alpha1-antagonist, worsens symptoms in human and canine subjects.
The pons is not the only neuroanatomic site that is responsible for mediating cataplexy; the mesocorticolimbic dopaminergic system also has been implicated. This connection with the limbic system in part explains the relationship of cataplexy to emotion.
The centrality of hypocretin transmission in the pathophysiology of narcolepsy was demonstrated when hypocretin knockout mice displayed cataplexy and sleepiness.[13, 14] Further evidence for impaired hypocretin functioning in humans was found with the discovery of low levels of hypocretin in the cerebrospinal fluid (CSF) of narcoleptic patients.
Subsequently, abnormal immune modulation was associated with the clinical development of narcolepsy in children in Scandinavia and Finland. After vaccination against the H1N1 influenza virus with a vaccine using a potent ASO3 adjuvant, narcolepsy in Finnish children increased 8- to 12-fold. All affected children who underwent HLA typing were found to have the HLA DQB*0602 allele.[16, 17]
Rapid eye movement sleep
Dysfunction and inappropriate regulation of rapid eye movement (REM) sleep are thought to exist in narcolepsy. Neuroanatomic control of REM sleep appears to be localized to the pontine reticular activating system.
The brain contains REM-on cells, which fire selectively during REM sleep periods, and REM-off cells, for which the converse holds true. Most REM-on cells function through cholinergic transmission, whereas REM-off cells are noradrenergic or serotonergic. In narcolepsy, monoamine-dependent inhibition of REM-on cells may be defective.
Symptoms can be viewed as REM sleep components intruding into wakeful states. For example, cataplexy and sleep paralysis represent an intrusion of REM sleep atonia, whereas hallucinations represent an intrusion of dreams.
The hypocretin system plays an important role in the pathophysiology of human narcolepsy. Patients with narcolepsy have been found to have little or no hypocretin in their CSF. Postmortem pathologic examination of the brains of people with narcolepsy with cataplexy have demonstrated dramatically reduced numbers of hypocretin neurons. Hypocretin deficiency is theorized to produce instability of sleep and wake states, thereby preventing the person from sustaining more continuous sleep or wakefulness.
A large majority of patients with narcolepsy without cataplexy have normal CSF hypocretin levels. However, a small pathologic study of the brains of patients who had narcolepsy without cataplexy showed partial loss of hypocretin neurons in the hypothalamus.[20, 21, 22]
Investigators have identified low levels of histamine (a neurotransmitter that may help maintain wakefulness) in the CSF of patients with hypocretin-deficient narcolepsy. Low CSF histamine levels are not limited to hypocretin-deficient narcolepsy, however; they are also seen in narcolepsy patients with normal CSF hypocretin levels and in patients with idiopathic hypersomnia.[23, 24]
It is noteworthy that low CSF histamine levels have not been found in patients with hypersomnia secondary to obstructive sleep apnea syndrome. The CSF histamine level may serve as a biomarker reflecting the degree of hypersomnia of central origin.[23, 24]
CNS nuclei for wakefulness and the relevant neurotransmitters generated in those nuclei include the following:
Locus ceruleus – Norepinephrine
Raphe nucleus – Serotonin
Tubomammillary nucleus – Histamine
Ventral tegmental area – Dopamine
Basal forebrain – Acetylcholine
These areas also inhibit REM sleep.
Hypocretin neurons, thought to be autoexcitatory, project from the lateral hypothalamus into these regions and serve to maintain wakefulness. A deficiency of hypocretin neurons may decrease the threshold for transitioning between wakefulness and sleep (so-called sleep state instability). This is a proposed explanation for the sleepiness and REM intrusion into wakefulness found in narcolepsy.
Destruction of hypocretin-producing neurons appears to be an autoimmune process. A study in a mouse model found that the serum of narcolepsy patients was reactive with over 86% of hypocretin neurons from the mouse hypothalamus. levels of a specific autoantigen against Tribbles homolog 2 (Trib2) have been found to be higher in narcolepsy patients with cataplexy than in normal controls or patients with other inflammatory neurologic disorders. High Trib2-specific antibody titers correlated with more severe cataplexy.
The autoimmune model of narcolepsy inspired trials of intravenous (IV) immunoglobulin (IVIG) therapy in narcoleptic patients with low levels of hypocretin-1. In these trials, IVIG reportedly improved cataplexy and sleepiness in many cases, but the effects did not last long. IVIG did not normalize CSF hypocretin levels, except in 1 patient. In 2 children given IVIG early after diagnosis of narcolepsy, the cataplexy and sleepiness improved, but some components of the disease worsened in 1 child.
The genetics of narcolepsy are complex. Whereas the concordance is only 35% in monozygotic twins, the risk is as high as 40% in first-degree relatives. Narcolepsy with cataplexy can be produced in animal models by disrupting the gene that encodes the hypocretin (orexin) receptor or ligand gene, thereby disrupting hypocretin neurotransmission.
There is a striking association between narcolepsy and the HLA haplotype DQA1*01:02-DQB1*06:02. A study in individuals of European descent found that nearly all of those with a diagnosis of narcolepsy with cataplexy carry the HLA haplotype DQA1*01:02-DQB1*06:02, compared with only 24% of the general population. Thus, carriage of this haplotype may be necessary but not sufficient for the development of narcolepsy.
A study of genome-wide expression in narcolepsy patients and controls showed an independent effect of allelic dosage of DQB1*06:02 on DQB1*06:02 mRNA levels and protein. This finding supports the suspicion that the risk of narcolepsy is higher in DQB1*06:02 homozygotes than in heterozygotes, suggesting that HLA is functionally involved in the occurrence of narcolepsy.
A genome-wide association study proposed a protective variant (DQB1*06:03). This allele may protect against autoimmune disorders; it is almost never seen in patients with narcolepsy.
Genome-wide association studies in Caucasians, with replication in 3 ethnic groups, have revealed associations between single-nucleotide polymorphisms (SNPs) in the T-cell receptor alpha locus and narcolepsy. This association further supports the autoimmune basis of narcolepsy.
An SNP in the purinergic receptor subtype P2Y11 gene (P2RY11) also appears to be associated with narcolepsy. P2RY11 has been identified as an important regulator of immune cell survival; the disease-associated P2RY11 correlates with a 3-fold lower expression of P2RY11 in CD8+ T-cells and natural killer cells, as well as with decreased P2RY11-mediated resistance to adenosine triphosphate–induced death in those cells.
A genome-wide association study that investigated 202 candidate genes in a replication study in 222 narcoleptic patients and 380 controls identified 6 genes that were associated with narcolepsy: NFATC2, SCP2, CACNA1C, TCRA, POLE, and FAM3D. These gene associations with narcolepsy were further supported by gene expression analyses showing that these same genes are also associated with essential hypersomnia, which is similar to narcolepsy.
United States statistics
The prevalence of narcolepsy in the US is 0.02-0.18%, which is comparable to that of multiple sclerosis.[36, 37] The frequency among first-degree relatives is 1-2% (10-40 times greater than that in the general population). The reported prevalence of narcolepsy in select populations is as follows:
North American blacks, 0.02%
Northern Californians, 0.05%
Southern Californian Caucasians, 0.07%
Narcolepsy with cataplexy affects 0.02% of adults worldwide. The reported prevalence of narcolepsy in select populations is as follows:
Israeli Jews and Arabs, 0.002%
Czech Caucasians, 0.02%
Finnish Caucasians, 0.026%
United Kingdom Caucasians, 0.04%
French Caucasians, 0.05%
Fujisawa Japanese teenagers, 0.16%
Japanese general population, 0.18%
Irish general population, 0.005% 
Sex- and age-related demographics
The male-to-female ratio in narcolepsy is 1.64:1. The age-of-onset distribution is bimodal, with the highest peak occurring at 15 years and a less pronounced peak occurring at 36 years. However, narcolepsy has been reported in children as young as 2 years.
With proper management and treatment, patients with narcolepsy usually lead meaningful and productive personal and professional lives. If left untreated, narcolepsy may be psychosocially devastating. Narcoleptic children may suffer poor school performance, social impairment, ridicule from peers, and dysfunction in other activities of normal childhood development.
Affected adults often perceive narcoleptic symptoms as embarrassing, and social isolation may result. They may encounter interpersonal stress in relationships, sexual dysfunction, and difficulty working as a consequence of either the disease itself or its treatment.
Job impairment may result from sleep attacks, memory problems, cataplexy, interpersonal problems, and personality changes. These symptoms may lead coworkers to perceive narcoleptics as lazy, inattentive, and lacking motivation. In one study, 24% of narcoleptic patients had to quit working and 18% were terminated from their jobs because of their disease.
People with narcolepsy sometimes are falsely suspected of illegal drug use. Patients should inform employers concerning their stimulant medications because they may test positive for amphetamines on screening preemployment drug tests.
Educate patients, parents, teachers, and other care providers concerning the symptoms, prognosis, and safety precautions. Advise patients of the increased risk of sleep-related driving accidents. Advise patients with narcolepsy about driving responsibilities.
As of March 1994, only 6 states in the United States (California, Maryland, North Carolina, Oregon, Texas, and Utah) had guidelines for narcoleptic drivers. In contrast, most Canadian provinces have guidelines, as does the United Kingdom, but whether such guidelines are effective in reducing traffic-related morbidity is unknown.
Vendrame M, Havaligi N, Matadeen-Ali C, Adams R, Kothare SV. Narcolepsy in children: a single-center clinical experience. Pediatr Neurol. 2008 May. 38(5):314-20. [Medline].
Plazzi G, Serra L, Ferri R. Nocturnal aspects of narcolepsy with cataplexy. Sleep Med Rev. 2008 Apr. 12(2):109-28. [Medline].
Palaia V, Poli F, Pizza F, Antelmi E, Franceschini C, Moghadam KK, et al. Narcolepsy with cataplexy associated with nocturnal compulsive behaviors: a case-control study. Sleep. 2011 Oct 1. 34(10):1365-71. [Medline]. [Full Text].
Plazzi G, Pizza F, Palaia V, Franceschini C, Poli F, Moghadam KK, et al. Complex movement disorders at disease onset in childhood narcolepsy with cataplexy. Brain. 2011 Dec. 134:3480-92. [Medline]. [Full Text].
Rogers AE, Aldrich MS, Lin X. A comparison of three different sleep schedules for reducing daytime sleepiness in narcolepsy. Sleep. 2001 Jun 15. 24(4):385-91. [Medline].
Benbadis SR. Effective treatment of narcolepsy with codeine in a patient receiving hemodialysis. Pharmacotherapy. 1996 May-Jun. 16(3):463-5. [Medline].
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA: American Psychiatric Association; 2013. 372-78.
American Academy of Sleep Medicine. The International Classification of Sleep Disorders-Revised: Diagnostic and Coding Manual. 3rd ed. Rochester, MN: American Academy of Sleep Medicine; 2014.
American Academy of Sleep Medicine. International Classification of Sleep Disorders,. 2nd ed. Darien, IL: American Academy of Sleep Medicine.; 2005.
Naumann A, Daum I. Narcolepsy: Pathophysiology and neuropsychological changes. Behav Neurol. 2003. 14(3,4):89-98. [Medline].
Lin L, Faraco J, Li R, et al. The sleep disorder canine narcolepsy is caused by a mutation in the hypocretin (orexin) receptor 2 gene. Cell. 1999 Aug 6. 98(3):365-76. [Medline].
Chemelli RM, Willie JT, Sinton CM, Elmquist JK, Scammell T, Lee C, et al. Narcolepsy in orexin knockout mice: molecular genetics of sleep regulation. Cell. 1999 Aug 20. 98(4):437-51. [Medline].
Mignot E, Lammers GJ, Ripley B, Okun M, Nevsimalova S, Overeem S, et al. The role of cerebrospinal fluid hypocretin measurement in the diagnosis of narcolepsy and other hypersomnias. Arch Neurol. 2002 Oct. 59(10):1553-62. [Medline].
Partinen M, Saarenpää-Heikkilä O, Ilveskoski I, Hublin C, Linna M, Olsén P, et al. Increased incidence and clinical picture of childhood narcolepsy following the 2009 H1N1 pandemic vaccination campaign in Finland. PLoS One. 2012. 7(3):e33723. [Medline]. [Full Text].
Nohynek H, Jokinen J, Partinen M, Vaarala O, Kirjavainen T, Sundman J, et al. AS03 adjuvanted AH1N1 vaccine associated with an abrupt increase in the incidence of childhood narcolepsy in Finland. PLoS One. 2012. 7(3):e33536. [Medline]. [Full Text].
Abad VC, Guilleminault C. Review of rapid eye movement behavior sleep disorders. Curr Neurol Neurosci Rep. 2004 Mar. 4(2):157-63. [Medline].
Mignot E, Lammers GJ, Ripley B, Okun M, Nevsimalova S, Overeem S, et al. The role of cerebrospinal fluid hypocretin measurement in the diagnosis of narcolepsy and other hypersomnias. Arch Neurol. 2002 Oct. 59(10):1553-62. [Medline].
Thannickal TC, Moore RY, Nienhuis R, Ramanathan L, Gulyani S, Aldrich M, et al. Reduced number of hypocretin neurons in human narcolepsy. Neuron. 2000 Sep. 27(3):469-74. [Medline].
Blouin AM, Thannickal TC, Worley PF, Baraban JM, Reti IM, Siegel JM. Narp immunostaining of human hypocretin (orexin) neurons: loss in narcolepsy. Neurology. 2005 Oct 25. 65(8):1189-92. [Medline].
Nishino S, Sakurai E, Nevsimalova S, Yoshida Y, Watanabe T, Yanai K. Decreased CSF histamine in narcolepsy with and without low CSF hypocretin-1 in comparison to healthy controls. Sleep. 2009 Feb 1. 32(2):175-80. [Medline]. [Full Text].
Kanbayashi T, Kodama T, Kondo H, Satoh S, Inoue Y, Chiba S. CSF histamine contents in narcolepsy, idiopathic hypersomnia and obstructive sleep apnea syndrome. Sleep. 2009 Feb 1. 32(2):181-7. [Medline]. [Full Text].
Overeem S, Black JL 3rd, Lammers GJ. Narcolepsy: immunological aspects. Sleep Med Rev. 2008 Apr. 12(2):95-107. [Medline].
Cvetkovic-Lopes V, Bayer L, Dorsaz S, Maret S, Pradervand S, Dauvilliers Y, et al. Elevated Tribbles homolog 2-specific antibody levels in narcolepsy patients. J Clin Invest. 2010 Mar. 120(3):713-9. [Medline]. [Full Text].
Dauvilliers Y, Abril B, Mas E, Michel F, Tafti M. Normalization of hypocretin-1 in narcolepsy after intravenous immunoglobulin treatment. Neurology. 2009 Oct 20. 73(16):1333-4. [Medline].
Knudsen S, Mikkelsen JD, Bang B, Gammeltoft S, Jennum PJ. Intravenous immunoglobulin treatment and screening for hypocretin neuron-specific autoantibodies in recent onset childhood narcolepsy with cataplexy. Neuropediatrics. 2010 Oct. 41(5):217-22. [Medline].
Mignot E. Sleep, sleep disorders and hypocretin (orexin). Sleep Med. 2004 Jun. 5 Suppl 1:S2-8. [Medline].
Weiner Lachmi K, Lin L, Kornum BR, Rico T, Lo B, Aran A, et al. DQB1*06:02 allele-specific expression varies by allelic dosage, not narcolepsy status. Hum Immunol. 2012 Apr. 73(4):405-10. [Medline]. [Full Text].
Hor H, Kutalik Z, Dauvilliers Y, Valsesia A, Lammers GJ, Donjacour CE, et al. Genome-wide association study identifies new HLA class II haplotypes strongly protective against narcolepsy. Nat Genet. 2010 Sep. 42(9):786-9. [Medline].
Hallmayer J, Faraco J, Lin L, Hesselson S, Winkelmann J, Kawashima M, et al. Narcolepsy is strongly associated with the T-cell receptor alpha locus. Nat Genet. 2009 Jun. 41(6):708-11. [Medline]. [Full Text].
Shimada M, Miyagawa T, Kawashima M, Tanaka S, Honda Y, Honda M, et al. An approach based on a genome-wide association study reveals candidate loci for narcolepsy. Hum Genet. 2010 Oct. 128(4):433-41. [Medline].
Longstreth WT Jr, Koepsell TD, Ton TG, Hendrickson AF, van Belle G. The epidemiology of narcolepsy. Sleep. 2007 Jan 1. 30(1):13-26. [Medline].
Silber MH, Krahn LE, Olson EJ, Pankratz VS. The epidemiology of narcolepsy in Olmsted County, Minnesota: a population-based study. Sleep. 2002 Mar 15. 25(2):197-202. [Medline].
Dauvilliers Y, Arnulf I, Mignot E. Narcolepsy with cataplexy. Lancet. 2007 Feb 10. 369(9560):499-511. [Medline].
Doherty L, Crowe C, Sweeney B. National narcolepsy survey. Ir Med J. 2010 Apr. 103(4):110, 112-3. [Medline].
Douglas NJ. The psychosocial aspects of narcolepsy. Neurology. 1998 Feb. 50(2 Suppl 1):S27-30. [Medline].
Pakola SJ, Dinges DF, Pack AI. Review of regulations and guidelines for commercial and noncommercial drivers with sleep apnea and narcolepsy. Sleep. 1995 Nov. 18(9):787-96. [Medline].
Guilleminault C, Pelayo R. Narcolepsy in prepubertal children. Ann Neurol. 1998 Jan. 43(1):135-42. [Medline].
Bassetti C, Aldrich MS, Quint DJ. MRI findings in narcolepsy. Sleep. 1997 Aug. 20(8):630-1. [Medline].
Melberg A, Hetta J, Dahl N, et al. Autosomal dominant cerebellar ataxia deafness and narcolepsy. J Neurol Sci. 1995 Dec. 134(1-2):119-29. [Medline].
Dauvilliers Y, Baumann CR, Carlander B, Bischof M, Blatter T, Lecendreux M, et al. CSF hypocretin-1 levels in narcolepsy, Kleine-Levin syndrome, and other hypersomnias and neurological conditions. J Neurol Neurosurg Psychiatry. 2003 Dec. 74(12):1667-73. [Medline].
Vossler DG, Wyler AR, Wilkus RJ, et al. Cataplexy and monoamine oxidase deficiency in Norrie disease. Neurology. 1996 May. 46(5):1258-61. [Medline].
Maeda M, Tamaoka A, Hayashi A, et al. [A case of HLA-DR2, DQw1 negative post-traumatic narcolepsy]. Rinsho Shinkeigaku. 1995 Jul. 35(7):811-3. [Medline].
Fry JM. Treatment modalities for narcolepsy. Neurology. 1998 Feb. 50(2 Suppl 1):S43-8. [Medline].
US Modafinil in Narcolepsy Multicenter Study Group. Randomized trial of modafinil as a treatment for the excessive daytime somnolence of narcolepsy. Neurology. 2000 Mar 14. 54(5):1166-75. [Medline].
Golicki D, Bala MM, Niewada M, Wierzbicka A. Modafinil for narcolepsy: systematic review and meta-analysis. Med Sci Monit. 2010 Aug. 16(8):RA177-86. [Medline].
The Nuvigil website. Available at www.nuvigil.com. Accessed: 12/8/2009.
Xyrem Web site. Available at www.xyrem.com.
Lockrane B, Bhatia P, Gore R. Successful treatment of narcolepsy and cataplexy: A review. Can Respir J. 2005 May-Jun. 12(4):225-7. [Medline].
Black J, Pardi D, Hornfeldt CS, Inhaber N. The nightly use of sodium oxybate is associated with a reduction in nocturnal sleep disruption: a double-blind, placebo-controlled study in patients with narcolepsy. J Clin Sleep Med. 2010 Dec 15. 6(6):596-602. [Medline]. [Full Text].
Vignatelli L, D'Alessandro R, Candelise L. Antidepressant drugs for narcolepsy. Cochrane Database Syst Rev. 2005 Jul 20. CD003724. [Medline].
[Guideline] Morgenthaler TI, Kapur VK, Brown T, Swick TJ, Alessi C, Aurora RN, et al. Practice parameters for the treatment of narcolepsy and other hypersomnias of central origin. Sleep. 2007 Dec. 30(12):1705-11. [Medline]. [Full Text].
Spencer TJ, Madras BK, Bonab AA, Dougherty DD, Clarke A, Mirto T, et al. A positron emission tomography study examining the dopaminergic activity of armodafinil in adults using [¹¹C]altropane and [¹¹C]raclopride. Biol Psychiatry. 2010 Nov 15. 68(10):964-70. [Medline].