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Narcolepsy in a young patient with management during pregnancy
Narcolepsy is a rare, disabling and chronic sleep disorder. It is characterized by excessive daytime sleepiness. There is narcolepsy with cataplexy and narcolepsy without cataplexy. Low cerebrospinal ﬂuid hypocretin levels are reported in narcolepsy patients. Narcolepsy occurs as frequently in women as in men. In most cases, the age of onset is between 15 and 40 years, thereby affecting many women in their childbearing years.
A 32 year woman, without comorbidities, started to suffer from excessive sleepiness since she was 23 years. She had sleep attacks, with excessive sleepiness and naps during activities that hindered her performance at work and social life. She reports at the same time frequent episodes of sleep paralysis. She also had fragmented sleep, with a sensation of non-restorative sleep and nocturnal awakenings. She denies a history of cataplexy and hypnagogic hallucinations. Investigation of secondary causes without alterations was carried out, in addition to normal polysomnography, only multiple sleep latency test with latency of 10 and three episodes of sleep onset in REM. Then non-pharmacological treatment was started with measures of sleep hygiene, naps, psychotherapy and pharmacological treatment with Methylphenidate 30mg/day and sporadic use of caffeine by the patient's choice, with good control of excessive sleepiness and cessation of paralysis of sleep. At 32 years, the patient became pregnant when the medication was withdrawn, non-pharmacological measures were reinforced and the use of caffeine continued at the patient's choice, with frequent monitoring during prenatal care to avoid side effects of caffeine, and obstetrical indication for the route of delivery. During follow-up, the patient had no complications, with relative control of excessive sleepiness, with no new episodes of sleep paralysis.
Although narcolepsy is a rare sleep disorder, we must maintain a low threshold for diagnosis as it is potentially treatable, with a significant improvement in quality of life. Due to its incidence, it is common to find female patients of childbearing age or even pregnant women, requiring frequent follow-up, discontinuation of medications with possible teratogenic effects, reinforcement of non-pharmacological measures and comprehensive care with the obstetrician, as in the case described.
narcolepsy, pregnant, cataplexy, childbearing, sleep
Relato de Caso
Faculdade de Medicina de Botucatu - UNESP - São Paulo - Brasil
Julio Cesar dos Santos Moreira, Guilherme Drumond Anastacio Jardini, Hendrick Henrique Fernandes Gramasco, Stella de Angelis Trivellato, Camila Bonfanti Baima, Ronaldo Guimarães Fonsenca