Diagnosis and Treatment of the Narcolepsy Syndrome
GERALD BOWLING, M.D.
Department of Internal Medicineand
NELSON G. RICHARDS, M.D.
Department of Neurology
THE narcolepsy syndrome is known also as Gélineau's disease, the Gélineau-Redlich syndrome, paroxysmal sleep, and sleep epilepsy. Because of the comparative rarity of the disease and our lack of understanding of the term narcolepsy, we recently had difficulty in diagnosing several cases of the syndrome. This report undertakes to clarify the meaning of the term, to discuss the entity, and to report an analysis of 75 case records of narcoleptics treated at the Cleveland Clinic in the last nine years.
In the past it has been alleged that the sleep of the narcoleptic is paroxysmal in onset.1Hypersomnolence has frequently been used to describe the condition in which the patient is persistently drowsy without having actual sleeping spells, or in which he falls asleep perhaps only once a day while engaged in some activity. Yoss and Daly2 recently defined narcolepsy as consisting of four components: (1) narcolepsy proper — “excessive and persistent sleepiness”; (2) cataplexy — muscular weakness induced by emotion; (3) sleep paralysis — transient, benign loss of muscle tone at the beginning or end of sleep; (4) hypnagogic hallucinations — usually vivid auditory or visual hallucinations or illusions occurring during day or night drowsiness, usually with sleep paralysis. We are essentially in agreement with their definition. In our 75 patients, excessive and persistent sleepiness occurred alone or in combination with other symptoms. Figure 1 illustrates the incidence of the four components of the narcolepsy syndrome in our patients. (1) Narcolepsy (excessive sleepiness) was present in all 75 patients. (2) Cataplectic attacks in . . .