Patient Case #2: 27-Year-Old Woman With Cataplexy
Thomas E. Scammell, MD reviews the history and current symptoms of a patient with narcolepsy.
EP: 1.Challenges in the Diagnosis of Narcolepsy
EP: 2.Patient Case #1: 19-Year-Old Man With Excessive Daytime Sleepiness
EP: 3.Clinical Impressions from Patient Case #1
EP: 4.The Role of Multidisciplinary Teams and Treatment Options
EP: 5.Non-Pharmacological Approaches and Counseling
EP: 6.Pharmacological Treatment Approaches
EP: 7.Challenges in the Management of Narcolepsy
EP: 8.New Directions in Treatment
EP: 9.Patient Case #2: 27-Year-Old Woman With Cataplexy
EP: 10.Clinical Impressions From Patient Case #2
EP: 11.Goals of Therapy and Factors That Shape Narcolepsy Treatment
EP: 12.Key Takeaways and the Future of Narcolepsy Treatment
Thomas E. Scammell, MD: Let's move on to another case, because it'll touch on some of the other facets of narcolepsy management. This is a 27-year-old woman, who was previously diagnosed with depression and daytime sleepiness. Now she is coming in to talk to her psychiatrist because she is having episodes of whole-body weakness, which has actually caused her to fall. She has been treated with paroxetine since she was about 24 years old. She also takes amphetamines/dextroamphetamine, extended release 30 milligrams each day. She has been on that for the last couple of years for her sleepiness. In the last couple of months, she says her mood has improved and the paroxetine was stopped three weeks ago. Since then, she's had three episodes of weakness which are really very striking. She says each one lasts about 30 to 60 seconds. With the first couple episodes her head slumped forwards, her speech was slurred, and with the third episode, she was joking with a friend, and she got so weak that she actually had to slump into a chair and she could not even stand up for a minute. She found these extremely bizarre and frightening. She is also not terribly happy with the amphetamine/dextroamphetamine because she thinks it makes her lose her appetite. She has had some weight loss with it. She also thinks it's causing headaches, a racing heart, and irritability. She also has anxiety and she's taking alprazolam and buspirone for that. As far as her past history I mentioned she's had depression for the last three years or so, she has got anxiety and she has daytime sleepiness. No illicit drugs, no alcohol, she's married, she has a couple of kids, her labs are all fine.
Transcript edited for clarity
