A small but important advance for sleep health in children.

Narcolepsy is a chronic neurological disorder that affects both adults and children. It is characterised by excessive sleepiness, vivid dreams at sleep onset, a momentary inability to move the body as the patient drifts off to sleep, cataplexy, and disturbed night sleep. With a prevalence of 25–50 per 100 000, it is almost as common as Crohn's disease and ulcerative colitis, 1 Kappelman MD Rifas-Shiman SL Kleinman K et al. The prevalence and geographic distribution of Crohn's disease and ulcerative colitis in the United States. Clinical Gastroenterology and Hepatology. 2007; 5: 1424-1429 Summary Full Text Full Text PDF PubMed Scopus (754) Google Scholar , 2 Silber MH Krahn LE Olson EJ et al. The epidemiology of narcolepsy in Olmsted county: a population-based study. Sleep. 2002; 25: 197-202 Crossref PubMed Scopus (364) Google Scholar but less known among health-care professionals. Cataplexy, the defining feature of type 1 narcolepsy, is associated with episodes of transient skeletal muscle weakness in response to emotional stimuli like laughter or surprise. Type 1 narcolepsy is an autoimmune disorder associated with a deficiency of hypocretin (orexin), a wakefulness promoting peptide, in the CNS. 3 Luo G Zhang J Lin L Mignot EJ Characterization of T cell receptors reactive to HCRTNH2, pHA273–287, and NP17–31 in control and narcolepsy patients. PNAS. 2022; 119e2205797119 Crossref Scopus (1) Google Scholar The pathophysiology of type 2 narcolepsy has not been definitively established. A delay of up to 10 years between the onset of symptoms and diagnosis is common. 4 Zhang Z Dauvilliers Y Plazzi G et al. Idling for decades: a European study of risk factors associated with the delay before a narcolepsy diagnosis. Nat Sci Sleep. 2022; 31: 1031-1047 Crossref Scopus (5) Google Scholar Furthermore, making a diagnosis of narcolepsy in children is difficult because some children are unable to explain their symptoms in detail. Safety and efficacy of pitolisant in children aged 6 years or older with narcolepsy with or without cataplexy: a double-blind, randomised, placebo-controlled trialPitolisant treatment resulted in an improvement in narcolepsy symptoms in children, although the UNS was not validated for use in children with narcolepsy when our study began. The safety profile was similar to that reported in adults but further studies are needed to confirm long-term safety. Full-Text PDF