Narcolepsy in a Pre-teen Girl: A Case Report

Abstract

Background: Narcolepsy is a neurological disorder, the main classic feature of which is excessive day time sleepiness (EDS), with recurrent episodes of irresistible sleep (sleep attacks). It is thought to result from genetic predisposition, abnormal neurotransmitter functioning and sensitivity, and abnormal immune modulation. The onset of narcolepsy symptoms usually starts in late 2nd or 3rd decade of life. Rare cases of narcolepsy have been reported to occur in the first decade of life, even in infants. We are presenting a case of narcolepsy in a 10 years old girl, who presented at Livingstone Central Hospital. This case has been presented due to rarity of this condition in this age group. To the best of our knowledge, this is the first documented case of narcolepsy in a pre-teenaged child in Zambia.
Objective: To familiarize the health workers about narcolepsy and diagnostic challenges it pose in resource poor Zambian health settings.
Case History: A10 years old girl was brought to the pediatrics department of Livingstone Central Hospital by her mother with complaints of having episodes of EDS for the past three years. The onset was insidious and episodes had increased in frequency in past 3 years. She used to sleep while in the class, during talking and sometimes during eating. There was no history of having cataplexy, hallucinations or sleep paralysis. Clinical diagnosis of narcolepsy without cataplexy was made and she was treated with oral fluoxetine and modafanil. She was discharged after staying in the hospital for 6 days. At her follow up after 3weeks, the patient had responded well to treatment and was free of those episodes of day time sleepiness. Currently the patient is doing fine and still on the same treatment.Her FBC, DLC, ESR, LFTs, Urine routine & microscopy, HIV test, all came out normal. She was weighing 43 Kg and was 1.43m tall. Her CT scan of brain didn't show any abnormality. Her physical & neurological examinations were unremarkable.
Conclusion: Narcolepsy in children is a rare condition but once it presents, it poses diagnostic challenges in Zambia due to unavailability of sleep laboratories and lack of knowledge among health workers about this disorder.