Indian Journal of Sleep Medicine

Register      Login

VOLUME 15 , ISSUE 1 ( January-March, 2020 ) > List of Articles

Original Article

Three Narcoleptics with Restless Leg Syndrome

Dipti Gothi, Agarwal Mohit, Deshmukh Ishani

Keywords : Iron deficiency, Narcolepsy with cataplexy, Polysomnography, Restless leg syndrome

Citation Information : Gothi D, Mohit A, Ishani D. Three Narcoleptics with Restless Leg Syndrome. Indian Sleep Med 2020; 15 (1):5-8.

DOI: 10.5005/jp-journals-10069-0049

License: CC BY-NC 4.0

Published Online: 01-03-2020

Copyright Statement:  Copyright © 2020; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

We are reporting the third largest Indian narcolepsy case series. Among 250 consecutive patients referred to our sleep center for polysomnography (PSG), 3 of them were diagnosed to have narcolepsy with cataplexy (NC). They had history of excessive daytime sleepiness (EDS) and sudden loss of muscle power leading to fall without alteration in consciousness. Their polysomnographies did not have obstructive sleep apnea (OSA). All of them had multiple sleep latency test (MSLT) showing sleep latency of less than 8 minutes and two sleep-onset rapid eye movement period (SOREMP). Since narcolepsy patients commonly have restless leg syndrome (RLS), RLS was studied in detail in them. All our patients with NC had RLS. The patients from Western countries with NC and RLS have normal or high iron level. But the serum iron level was low in two patients and normal in one patient. The management of RLS secondary to iron deficiency is thus an important component of NC in Indian patients. Key messages: • Clinical history is very important for suspicion of narcolepsy. • Multiple sleep latency test is diagnostic of narcolepsy in the current clinical context. • Restless leg syndrome is diagnosed on history alone. Since it occurs commonly with narcolepsy, history of RLS in important in narcolepsy patients. • Iron deficiency can also be causative factor for RLS in narcolepsy in Indian patients though it is reported to be due to narcolepsy itself in Western counterparts. • Modafinil alone is not useful in the treatment of narcolepsy; a tailor-made pharmacological and supportive non-pharmacological approach is essential.


PDF Share
  1. Sateia MJ. International classification of sleep disorders third edition. Chest 2014;146(5):1387–1394. DOI: 10.1378/chest.14-0970.
  2. Plazzi G, Ferri R, Dauvilliers Y. Narcolepsy and restless legs syndrome. Sleep 2010;33(5):689–694. DOI: 10.1093/sleep/33.5.689.
  3. Barateau L, Dauvilliers Y. Recent advances in treatment for narcolepsy. Ther Adv Neurol Disord 2019;12:1–12. DOI: 10.1177/1756286419875622.
  4. Ray A. A four year experience in narcolepsy from a sleep clinic at a tertiary care centre with a short review of contemporary Indian literature. Indian J Med Res 2018;148(6):748–751. DOI: 10.4103/ijmr.IJMR_888_16.
  5. Yeh P, Walters AS, Tsuang JW. Restless legs syndrome: a comprehensive overview on its epidemiology, risk factors, and treatment. Sleep Breath 2012;16(4):987–1007. DOI: 10.1007/s11325-011- 0606-x.
  6. Scammell TE. Narcolepsy. N Engl J Med 2015;373(27):2654–2662. DOI: 10.1056/NEJMra1500587.
  7. Gupta AK, Sahoo S, Grover S. Narcolepsy in adolescence-a missed diagnosis: a case report. Innov Clin Neurosci 2017;14(7-8):20–23.
  8. Littner MR, Kushida C, Wise M, et al. Standards of practice committee of the american academy of sleep medicine. Practice parameters for clinical use of the multiple sleep latency test and the maintenance of wakefulness test. Sleep 2005;28(1):113–121. DOI: 10.1093/sleep/28.1.113.
  9. Reading PJ. Update on narcolepsy. J Neurol 2019;266(7):1809–1815. DOI: 10.1007/s00415-019-09310-3.
  10. Gothi D. Sleep disorders in chronic obstructive pulmonary disease. Indian J Sleep Med 2015;10(1):11–21.
  11. Gonzalez LP, Malkani RG. Update on restless legs syndrome: from mechanisms to treatment. Curr Neurol Neurosci Rep 2019;19(8):54. DOI: 10.1007/s11910-019-0965-4.
  12. Gupta A, Shukla G, Goyal V, et al. Clinical and polysomnographic characteristics in 20 North Indian patients with narcolepsy. A seven year experience from a neurology service sleep clinic. Neurol India 2012;60(1):75–78. DOI: 10.4103/0028-3886.93602.
  13. Swick TJ. Treatment paradigms for cataplexy in narcolepsy: past, present, and future. Nature and Science of Sleep 2015;7:159–169. DOI: 10.2147/NSS.S92140.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.