Statistics that frightens – misdiagnosis of Narcolepsy
I was browsing a few medical articles trying to find out more about pseudoseizures and cataplexy when I came across ‘Narcolepsy Presenting as Pseudoseizures’ written by Charles K. Dunham MD. This article was published in 2010.
Failure rates among physicians for diagnosing narcolepsy are high:
neurologists 45%, internists 76.5%, general practitioners 78.1%, psychiatrists 88.9%, and pediatricians 100%.
Common misdiagnoses included:
neurotic disorders, depression, personality disorders, and adjustment reactions.
Narcolepsy classically presents with excessive sleepiness, cataplexy, sleep paralysis, and hypnagogic hallucinations. Diagnosis is based on clinical history and confirmed after polysomnogram and a multiple sleep latency test. A multiple sleep latency test with short mean sleep latency and rapid eye movement sleep after 2 or more naps is highly suggestive of narcolepsy.
Despite improvements in diagnosing conversion disorder, physicians should be mindful that an estimated 1 in 25 patients are misdiagnosed. A patient with conversion disorder and excessive daytime sleepiness, cataplexy, sleep paralysis, or hypnagogic hallucinations may suffer from narcolepsy. Narcolepsy is estimated to occur in 0.03%–0.16% of the general population. Cataplexy with excessive daytime sleepiness is almost unique to narcolepsy.However, cases of cataplexy being diagnosed as psychiatric issues such as conversion disorder and malingering and psychosis are known. Referral to a sleep specialist for polysomnogram and multiple sleep latency test to objectively evaluate narcolepsy is warranted.
This is hardly news for narcoleptics everywhere, still the information is incredible. How many more people are going to have to suffer because the medical professions don’t recognise a sleeping disorder that is as common as Parkinson’s and MS. Sleep disorder are not really studied at medical colleges, well apparently 20min of the education is devoted to it. Only if a budding dr. have a specialist interest in sleep and similar processes will they familiarise themselves with symptoms through work experience. Sleep researchers receive very little funding – understandably because there’s no money to be made for the pharmaceutical companies in treating the cause rather than the symptoms.
At the same time, paradoxically, Sleep is becoming fashionable. Stylist (free fashion magazine) wrote last week about the three cornerstones of a healthy life: Nutrition, exercise and SLEEP.