A consistent individual pattern is seen. Attacks vary in frequency from more than 10 per day to less than 1 per month. Hypnagogic hallucinations (at sleep onset) or hypnapompic hallucinations (on waking) represent vivid dreamlike experiences of visual imagery (constant or changing colored forms), auditory hallucinations, or tactile sensations. Smell and taste are rarely affected. Some patients describe out-of-body experiences at sleep onset. Attacks usually last less than 10 min,

and the frequency varies from less than once a month Inhibitors,research,lifescience,medical to more than once a day. Sleep paralysis represents inability to move either at sleep onset or upon awakening; the episode can last up to 10 min. Patients can be frightened because they are unable to open their eyes or move their fingers Inhibitors,research,lifescience,medical and feel they have to struggle to move. Disturbed nocturnal sleep is the fifth component of the “tetrad” and is due to frequent awakenings. Although patients typically have short SOL, they may have trouble returning to sleep once awakened. Other reported symptoms include automatic behavior (episodes of amnesia associated with semipurposeful activity), subjective memory impairment that is not validated during standard memory testing, tiredness or fatigue, blurry or double vision, and sexual dysfunction (which may be related to drug therapy).124 The PSG Inhibitors,research,lifescience,medical demonstrates SOL less than 10 min

and REM sleep latency less than 20 min.4 An MSLT demonstrates a mean sleep latency of less than 5 min with two or more sleep-onset REM (SOREM) episodes.4 Figure 2 depicts SOREM during an MSLT nap. Figure 2. Sleep-onset rapid Inhibitors,research,lifescience,medical eye movement (REM) during an mean sleep latency test (MSLT) nap in a patient with narcolepsy. Electroencephalogram (EEG) leads (C3-A2 and 02-A1) demonstrate low voltage mixed frequency theta activity. EMG-Chin shows atonia Inhibitors,research,lifescience,medical with phasic … HLA typing demonstrates an increased frequency of DQB1 *0602 or DR2 in patients with narcolepsy, especially with cataplexy. Low CSF levels of hypocretin-1

are highly associated with narcolepsy with cataplexy (89.5%), particularly in patients with cataplexy who are HLA DQBl*0602-positive (95.7%).129-132 Stimulant medications Cilengitide are the mainstay of treatment of EDS, with the objective of allowing the fullest possible return of normal function for patients at work, home, and school.118,122,123,125,133-135 The most common stimulants used, listed in incrementing order of relative efficacy are: pemoline, modafinil, dextroamphetamine, mcthamphetamine, and methylphenidate.133,135 The maximum recommended daily dosages of stimulants in adults are: dextroamphetamine sulfate, 100 mg; methamphetamine hydrochloride, 80 mg; and methylphenidate, 100 mg.133 Pemoline was utilized in the past, but is not currently recommended due to concerns about the risk of acute hepatic failure.