Consideration of narcolepsy in the diagnosis of Chronic Fatigue Syndrome (CFS)

OBJECTIVE: To justify the inclusion of narcolepsy in the
differential diagnosis of patients with chronic fatigue.

CLINICAL FEATURES: We report three patients aged 17 (two women
and one man) and one woman aged 45 who had been diagnosed as
having chronic fatigue syndrome (CFS). They had no psychiatric
illness. Their main problem was severe daytime sleepiness,
presenting as "tiredness and fatigue". The history, sleep
study and multiple sleep latency test suggested a diagnosis of
narcolepsy.

INTERVENTION: Treatment with methylphenidate
resulted in complete resolution of symptoms in two patients
and significant improvement in the other two.

CONCLUSIONS: The
differential diagnosis of CFS requires the exclusion of other
conditions. If daytime sleepiness is a major complaint, other
symptoms of narcolepsy should be sought and the diagnosis
confirmed with sleep study and a multiple sleep latency test.

Ambrogetti A, Olson LG

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