Narcolepsy

   Narcolepsy means sudden, irresistible sleep attacks, often accompanied by cataplexy (sudden loss of muscle tone), "hypnagogic" hallucinations ( just before falling asleep), and sleep paralysis (sensation of being figuratively nailed to the bed). Although physicians going back to the seventeenth century had described the phenomenon, the first modern characterization of it comes from Berlin psychiatry professor Carl Westphal (1833–1890) in 1877, as he lectured the Berlin Medical Society—in an article subsequently published in the Archiv für Psychiatrie und Nervenkrankheiten—about "Singular Seizures Associated with Falling Asleep" ("Eigenthümliche mit Einschlafen verbundene Anfälle"). "I myself have had repeated occasions to observe the attacks of this patient [a bookbinder named Ehlert]. He experienced one while I was talking to him. While he was still speaking . . . one sees that his eyelids are gradually drooping. . . . Then the patient stops speaking after mumbling something incomprehensible; his head sinks to his chest . . . and the patient now offers the picture of someone who has fallen asleep while seated" (p. 632). Three years later, in 1880, Jean-Baptiste-Édouard Gélineau (1859–1906), in two articles in the Parisian Gazette des hôpitaux, coined the term "narcolepsie": "I propose to give the name narcolepsy . . . to a rare, or at least little-known, neurosis characterized by an imperious, sudden and transitory need to sleep, occurring at more or less close intervals. This name will recall the double analogy of narcolepsy to somnolence and to catalepsy [cataplexy is meant*]" (p. 626).

   As for treatment, in 1930 John Benedict Doyle (1894–1971), an associate consultant in neurology at the Mayo Foundation in Rochester, Minnesota, and Luman E. Daniels (1895–1971), a resident in neurology there, proposed ephedrine for the treatment of narcolepsy; see the Proceedings of the Staff Meetings of the Mayo Clinic (1930). (This was 4 months after a similar report, in Czech, by Prague university psychiatrist Otakar Janota [1898–1969] in the Purkyne Society. So Janota had the priority but nobody knew it until he wrote about his discovery again in 1931 in German in the Medizinische Klinik.)

   In 1935, Myron Prinzmetal (1908–1987), a Los Angeles cardiologist (who described in 1955 a distinctive kind of angina named after him), and Wilfred Bloomberg (1905–1987), a Harvard psychiatrist, in the Journal of the American Medical Association suggested the newly introduced drug Benzedrine (racemic amphetamine sulfate) for * Catalepsy means wax-like postures; cataplexy, the sudden loss of muscle force, occurs in narcolepsy. As Gélineau himself said, "Moreover, even popular language in a manner of speaking has consecrated the usage in speaking of someone exhausted by late nights and work, ‘He’s falling down with sleep.’ [Il tombe de sommeil]" (p. 636). If Gélineau had not confused the two, the coinage would have been "narcoplexy." narcolepsy. They had done a controlled trial, one of the first in psychiatry. The amphetamines remained the treatments of choice in narcolepsy for many years. Narcolepsy is not primarily a psychiatric diagnosis, and its representation in

   DSM has been rather haphazard. Among the sleep disorders, DSM "One" (1952) and

   DSM-II (1968) discussed only somnambulism, or sleepwalking. DSM-III (1980) mentioned the term "narcolepsy" as one of the "disorders of excessive somnolence," without any discussion of it. DSM-III-R (1987) had a fuller account without making narcolepsy a separate diagnosis (still a form of hypersomnia). However, in

   DSM-IV in 1994, narcolepsy took wing as a disease of its own alongside other "sleep disorders."