An expert panel concludes the discussion by reviewing factors to consider when diagnosing and treating narcolepsy.
Thomas E. Scammell, MD: Many narcolepsy patients are managed by psychiatrists, and what do you see as some of the big take home messages here? Dr. Moawad?
Heidi Moawad, MD: I’m going to say these two patients were typical in many ways, and they're both fairly complicated. Things don't stay the same and consistent throughout the whole disease course. I think that expectation of symptomatic change over the years and morbid psychiatric issues is something that is pretty common with people who have narcolepsy.
Thomas E. Scammell, MD: Thank you. Dr. Zee?
Phyllis C. Zee, MD, PhD: I think with any patient that presents with excessive daytime sleepiness in practice, that narcolepsy should be in a differential diagnosis. It's not common necessarily, but it should be in a differential diagnosis. Also look at how medications may be masking some of the symptoms of cataplexy for example, as we saw in this patient. I think to ask questions beyond that about cataplexy, perhaps about sleep paralysis and hypnagogic hallucinations, just to consider it. It doesn’t take that much time. Just consider it.
Thomas E. Scammell, MD: It's a few more questions to ask and it's worth drilling in. Dr. Benca?
Ruth Benca, MD, PhD: So, again, another take home, particularly for psychiatrists is a lot of our patients complain about sleepiness and tiredness. Some of them are going to have narcolepsy, very few, but it's like finding the needle in the haystack. It's so critical to make the right diagnosis. We have a whole range of sleepy patients where we must tailor the treatment to their disease. And again, we want to neither over diagnosed nor under diagnosed narcolepsy.
Thomas E. Scammel, MD: That's well put. I think we're starting to run short on time here. But I want to thank all three of you for your great opinions. Appreciate lots of good ideas here. Thanks to the listeners for joining us for this Around the Practice program.
Transcript edited for clarity