发作性睡病36例临床分析

目的探讨发作性睡病的临床特征、诊断、治疗及预后。方法对36例发作性睡病患者进行睡眠脑电图监测,结合临床表现进行诊断,采用哌醋甲酯、氯酯醒、氯丙米嗪治疗,并进行随访。结果36例患者均有过度或发作性的不可抑制的白天睡眠,30例有夜间睡眠紊乱,25例伴猝倒,9例伴睡眠瘫痪,10例出现睡眠幻觉。睡眠脑电图监测显示36例患者平均睡眠潜伏期<5 min,有2次或2次以上直接进入快速眼动相睡眠。随访29例,其中20例采用哌醋甲酯治疗,17例白天过度睡眠得到改善;8例采用氯酯醒或合并氯丙米嗪治疗,5例症状改善;大多数患者出现不同程度的心理和学习问题。结论发作性睡病是慢性神经系统疾病,应根据其典型的临床表现及睡眠脑电监测结果作出早期诊断,对患者应给予长期的药物治疗、心理治疗和教育,以提高患者的生活质量。

Clinical analysis on patients with narcolepsy

Objective To study the clinical characteristics,diagnostic methods,management and prognosis of patients with narcolepsy.Methods Clinical data of 36 cases narcoleptic were analyzed.Sleep EEG monitoring was performed in all patients.Among 36 cases,29 patients were followed up.Results All the patients manifested with excessive daytime sleepiness were 30 cases with disrupted nocturnal sleep occurring.Cataplexy,sleep paralysis and hypnagogic hallucination appeared respectively in 25,9 and 10 cases.Sleep EEG monitoring demonstrated a short mean sleep latency(<5minutes) and two or more sleep on set REM periods(SOREMPs) in 36 cases.Twenty-nine patients were followed up.Methylphenidate was administered in 20 cases.The excessive daytime sleepiness had been improved in 17 cases(85%).Meclofenoxane and Chlorimipramine were administered in 8 cases.The excessive daytime sleepiness had been improved in 5 cases(62.5%).Psychosocial and academic problems appeared in most cases.Conclusion Narcolepsy is a chronic neurological disorder.A definite diagnosis is established when the symptoms of cataplexy and excessive daytime sleepiness occur in association with the characteristic findings on sleep EEG monitoring.Appropriate drug therapy and psychosocial treatment are helpful to the patients.Stimulant medication is an important component of over all treatment program.Psychosocial treatment and education are key elements in the management plan.The over all goal for managing narcolepsy is assist to the patients in achieving optimal quality of life.