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Advanced Neurologyurology
Advanced Ne Narcolepsy-multiple sclerosis coexistence

disorders and offering insights, for clinicians, into treating and NREM3 stages were found to be reduced, accounting
this rare comorbidity. for 35.3% and 9.6%, respectively. It is noteworthy that
the orexin A level in the patient’s cerebrospinal fluid
2. Case presentation was significantly reduced, measuring only at 8.49 pg/mL

In April 2023, a 21-year-old male who experienced a (normal range >200 pg/mL). Furthermore, testing of genes
notable increase in sleep duration over the past 5 years, associated with narcolepsy susceptibility revealed that the
accompanied by the urge to fall asleep, nightmares, and patient is homozygous for HLA-DQB1*06:02 and TCRA
sleep paralysis during waking hours, reached out to seek rs1154155, and heterozygous for P2RY11 rs2305795.
medical consultation in our clinic. These symptoms were These genetic markers, combined with the diminished
unpredictable and seemingly not correlated with changes orexin A levels, present a comprehensive overview of the
in the body position or other discernible triggers. He has patient’s predisposition. Upon integrating these findings,
no history of chronic diseases or relevant familial inherited the patient was provisionally diagnosed with narcolepsy
diseases. A series of evaluations regarding his condition type 1 according to the International Classification of Sleep
rd
[3]
were conducted. Disorders, 3 edition (ICSD-3) criteria .
Nocturnal polysomnography (nPSG) (Figure 1A-E) In July 2023, the patient experienced numbness in both
results revealed a marked reduction in the patient’s average lower limbs, and the condition deteriorated while he walked
sleep onset latency to just 1.75 min. In multiple sleep latency with his shoes on. He had no accompanying symptoms,
test, we found that the patient consistently entered rapid such as dizziness, headache, blurred vision, slurred
eye movement (REM) sleep prematurely with latencies speech, or impaired speech comprehension. Neurological
documented at 1.5 min, 7.5 min, and 14.5 min, respectively. examination revealed horizontal nystagmus in both eyes
The extended duration of the patient’s non-REM stage 1 from right to left, an abnormal sensation resembling the
(NREM1) sleep was also recorded, constituting 47.3% of feeling of wearing boots on both lower limbs, hyperactive
the entire sleep duration. Conversely, durations for NREM2 tendon reflexes in all limbs, positive bilateral Chaddock

A

B C

D E

Figure 1. (A-E) Typical images of nocturnal polysomnography reports in awake (A), non-REM stage 1 (NREM1) (B), NREM2 (C), NREM3 (D), and rapid
eye movement (E) stages.

Volume 2 Issue 4 (2023) 2 https://doi.org/10.36922/an.1913