Francisco G E, Ivanhoe C B
Department of Physical Medicine and Rehabilitation, Baylor college of Medicine, Houston, TX, USA.
Am J Phys Med Rehabil. 1996 Jan-Feb;75(1):63-5. doi: 10.1097/00002060-199601000-00016.
Narcolepsy is a rare sequela of brain injury. We report the case of a 27-yr-old male with post-traumatic narcolepsy who was successfully treated with methylphenidate. This patient sustained moderate brain injury from a motorcycle accident. Subsequently, he manifested the classic tetrad of narcolepsy: cataplexy, excessive daytime sleepiness, sleep paralysis, and hypnogogic hallucinations. There was no premorbid seizure or sleep disorder. There was no family history of sleep disorders. Polysomnography and Multiple Sleep Latency Test confirmed the diagnosis of narcolepsy. Sleep latency (time to sleep onset), rapid eye movement sleep latency (time from sleep onset to rapid eye movement sleep onset), and mean multiple sleep latency were all pathologically shortened (2.5, 66, and 1.2 min, respectively). Twenty-four hour electroencephalographic monitoring and magnetic resonance imaging of the brain were normal, as were serum chemistries. Treatment with caffeine was unsuccessful. He was then started on methylphenidate, 10 mg twice daily, which was increased to 30 mg twice daily over a 4-mo period. Cataplexy and excessive daytime sleepiness started to improve 1 mo after adjustments in methylphenidate dosing. Six months after the initiation of methylphenidate therapy, the patient is completely asymptomatic.
发作性睡病是脑损伤的一种罕见后遗症。我们报告一例27岁男性创伤后发作性睡病患者，经哌甲酯成功治疗。该患者因摩托车事故遭受中度脑损伤。随后，他出现了发作性睡病的典型四联症：猝倒、日间过度嗜睡、睡眠麻痹和入睡前幻觉。病前无癫痫或睡眠障碍。无睡眠障碍家族史。多导睡眠图和多次睡眠潜伏期试验确诊为发作性睡病。睡眠潜伏期（入睡时间）、快速眼动睡眠潜伏期（从入睡到快速眼动睡眠开始的时间）和平均多次睡眠潜伏期均病理性缩短（分别为2.5、66和1.2分钟）。24小时脑电图监测和脑部磁共振成像均正常，血清化学检查也正常。咖啡因治疗无效。然后开始给他服用哌甲酯，每日两次，每次10毫克，在4个月内增至每日两次，每次30毫克。调整哌甲酯剂量1个月后，猝倒和日间过度嗜睡开始改善。哌甲酯治疗开始6个月后，患者完全无症状。
