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David Parkes



Aetiology—discussion of seasonality of disease onset and association with upper respiratory tract infections.

Treatment—enhanced discussion of use of modafinil, selective serotonin reuptake inhibitors (SSRIs) and gamma hydroxybutyrate; discussion of trials of orexin antagonists.

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date: 27 September 2021

Narcolepsy is the specific syndrome of daytime sleepiness with cataplexy, where there is a sudden loss of muscle tone—often provoked by the anticipation of emotions—leading to a tendency to fall, mouth opening, dysarthria or mutism, and facial muscle jerking. It is associated with loss of hypocretin (orexin) neurons in the hypothalamus, hypocretin-1 concentrations in the cerebrospinal fluid below 100 ng/litre, and the HLA genotype DQ B1*0602. Once established, narcolepsy is lifelong; spontaneous recovery does not occur. Treatment—which is essential to restore school performance, work, driving ability and quality of life—is with stimulant (e.g. amphetamine) and anticataplectic (e.g. clomipramine) drugs, supported by a 15-min nap once or twice a day....

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