Is your child a "master of falling asleep in seconds"? Beware of "childhood narcolepsy"!

Have you ever seen a child like this?

He was chewing a chicken drumstick one second, and then he suddenly lost power and snored on the table the next. He would suddenly shut down when he was in class or doing homework. He would suddenly become paralyzed when laughing and couldn't even hold a chicken drumstick. He would cry and say "monster" before going to bed and wouldn't dare to close his eyes...

They are easy to:

Being misunderstood as a poor student by the teacher;

Being misunderstood by parents as being lazy;

He was laughed at as a monster by his classmates.

When “falling asleep in seconds” turns into “out-of-control mode”, is this a gifted “sleep assassin” or is the body quietly sounding the alarm?

Today, we will take a look at narcolepsy in children, a rare disease that causes the brain's "sleep switch" to go out of control!

1. Narcolepsy in children: The brain's "switch" fails

Narcolepsy is a chronic sleep-wake disorder. The core problem is that the brain lacks the "wakefulness-maintaining agent" - orexin.

Simply put, a baby’s brain is like a “TV with poor contact” and the screen may go black or the picture may jump randomly at any time!

Narcolepsy was first proposed by French doctor Gelineau in 1880. It is considered a rare disease internationally and has been included in my country's "Second Batch of Rare Diseases Catalogue". There are about 500,000 to 700,000 patients in China. The peak age of onset in my country is 8-12 years old. It can occur in early childhood. The average delay from onset to diagnosis is 8-22 years, which runs through the critical period of children's schooling and personality development. It is a lifelong disease that brings serious burdens to patients and their families, especially to children and adolescents.

2. Narcolepsy Tetralogy: Don’t mistake “illness” for “laziness”

1. Excessive daytime sleepiness (EDS): 100% of children have it

Daily behavior: fishing in class, napping while eating, and falling asleep in seconds while playing games, and still feeling sleepy after waking up.

Parents’ misunderstanding: They mistakenly think that it is “staying up late” and “being lazy”, but the sleepiness of narcolepsy is “irresistible”, like being “kidnapped by a sleepyhead”!

2. Cataplexy: 60-70%

Typical scenario: When laughing or getting angry, your muscles suddenly "lose power" - your knees become weak, your chin drops, the chicken leg in your hand "free falls", and in severe cases you may even fall to the ground.

Note: Mild symptoms may only include droopy eyelids or slurred speech, which can be easily overlooked!

3. Sleep paralysis: 25-50%

Horrible experience: The patient is conscious but the body is "sleep paralysis", which often happens when just falling asleep or about to wake up. Children may mistakenly think it is a "nightmare".

4. Hypnagogic hallucinations: 33-80%

Realistic hallucinations (such as monsters and strangers) appear after closing the eyes, causing the child to resist falling asleep.

In addition to the four core symptoms, the following manifestations may also occur:

● Fragmented sleep at night, often complaining of waking up easily, having many dreams, and difficulty falling asleep again after waking up;

● It is more common in children with comorbid mental disorders such as attention deficit hyperactivity disorder, anxiety/depression disorders, etc., which brings challenges to treatment;

● Symptoms of secondary REM sleep behavioral disorder: dream enactment behavior, etc.;

● Combined metabolic diseases: obesity, diabetes, etc.

3. Pathogenesis

The culprit: Orexin deficiency

● Hypocretin is the brain's "wakefulness-maintaining agent" responsible for drawing a clear line between "wakefulness" and "dreaming" (REM sleep).

● Due to immune abnormalities or genetic factors, the child’s secretion hormone is reduced, and the brain is like a “radio that randomly jumps between channels”: it mixes in “dreams” when awake, and frequently “changes channels” when sleeping!

4. Diagnosis: Stop guessing, scientific examination will tell the final word!

Diagnostic criteria (International Classification of Sleep Disorders ICSD-3).

1. Necessary condition: Daily excessive sleepiness lasting ≥ 3 months.

2. Confirmed combination:

● Polysomnography (PSG) + Multiple Sleep Latency Test (MSLT): monitor the quality of sleep at night and test the speed of falling asleep during the day (children with narcolepsy take an average of ≤8 minutes to fall asleep and have more than 2 episodes of "rapid eye movement sleep").

● Cerebrospinal fluid test: Confirm that the level of hypocretin 1 (Hcrt-1) is ≤110pg/ml (ultimate evidence).

5. Treatment: To level up and defeat monsters, you need a combination of

Drug treatment (lifelong, must strictly follow the doctor's advice).

Non-drug treatment: The whole family is mobilized!

● Regular work and rest schedule: Have a fixed sleep schedule and arrange 2-3 short naps (15-20 minutes) during the day.

● Emotion management: Avoid excessive excitement or tension, reduce the triggers of cataplexy, and teach children to use deep breathing to calm their emotions.

● Psychological support: Explain the condition to the school to avoid misunderstanding; help children understand the disease through picture books and games.

● Safety protection: Avoid swimming or cycling alone, prevent slipping in the bathroom, and prevent sudden falls and injuries.

6. Parents must read! Early identification of traffic lights

High-risk signal self-check list

● Falling asleep several times during the day and still feeling sleepy after waking up

● Sudden "collapse" when laughing/crying

● Frequent descriptions of "sleep paralysis" or "seeing scary things" before going to bed

● Uneasy sleep at night, but no snoring (ruling out snoring)

Epworth Sleepiness Scale for Children

Table rating: Never = 0 points; Rarely = 1 point; Mostly = 2 points; Often = 3 points

The total score ranges from 0 to 24. The higher the score, the more severe the daytime sleepiness. 0 to 8 is normal, 9 to 12 is mildly abnormal, 13 to 16 is moderately abnormal, and >16 is severely abnormal.

If the score is >16, it means that the daytime sleepiness is severe. You need to be highly alert to the possibility that your child has narcolepsy and should immediately go to the hospital for further professional examination.

7. Summary: Detect early and intervene early, don’t let your childhood be “trapped”!

Key point 1: Narcolepsy is not "laziness", but the brain lacks the "wakefulness switch"!

Key point 2: Falling asleep within seconds, cataplexy, hallucinations, sleep paralysis = seek medical attention as soon as possible!

Key point 3: PSG+MSLT+cerebrospinal fluid Hcrt-1 is the gold standard for diagnosis!

Key point 4: Treatment requires a two-pronged approach of medication + behavior!

A word to parents: If your child always falls asleep in seconds out of control, don’t hesitate, take him to a pediatric neurologist for an appointment! With scientific intervention, your child can still embrace every day full of energy!

Hunan Medical Chat Special Author: Xi Qiong and Xie Hao, Department of Pediatrics, Xiangya Third Hospital, Central South University

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(Edited by Wx)