Case Reports in Neurology (Nov 2020)

Rare Case of Late-Onset Narcolepsy Type 1

  • Petra Kovalská,
  • Simona Dostálová,
  • Hana Machová,
  • Petra Nytrová,
  • Eszter Maurovich Horvat,
  • Karel Šonka

DOI
https://doi.org/10.1159/000510633
Journal volume & issue
Vol. 12, no. 3
pp. 428 – 432

Abstract

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A 69-year-old male developed symptoms typical of the diagnosis of narcolepsy type 1 without any previous triggering events. First, daytime sleepiness occurred, soon followed by cataplexy. Nocturnal polysomnography revealed rapid eye movement (REM) sleep behavior disorder, a apnea-hypopnea index of 25.8 events/h, and no sleep-onset REM. Multiple Sleep Latency Test showed a mean sleep latency of 2.1 min and REM sleep in 3 tests. HLA DQB1*06:02 was positive and hypocretin-1 in cerebrospinal fluid unmeasurable. A treatment with 50 mg clomipramine controlled the cataplexy; excessive daytime sleepiness was sufficiently managed by repeated naps. The administration of 0.25 mg of clonazepam subjectively improved REM sleep behavior disorder. Bilevel Positive Airway Pressure improved the apnea-hypopnea index without important influence on sleepiness. Our unique case demonstrates that even elderly subjects can develop narcolepsy type 1.

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