Some subjects may report features reminiscent of cataplexy that are not clear-cut, either because they are mild, atypical or only subjective experiences, a situation termed “cataplexy-like” particularly when using questionnaires in population-based studies. Clear-cut or definite cataplexy is considered a pathognomonic symptom for diagnosing narcolepsy and is defined as more than one episode of generally brief and usually bilaterally symmetrical sudden loss of muscle tone with retained consciousness precipitated by strong emotions typically associated with laughter or elation. 7 There are neurological disorders that can cause secondary narcolepsy. HLA typing is a useful screen before lumbar puncture since 98 % of patients with hypocretin-1 deficiency are DQB1*06:02 positive. Hypocretin deficit is closely related to human leukocyte antigen (HLA) DQ B1*06:02 and cases of hypocretin-deficient narcolepsy without this HLA haplotype are exceptional. The mechanism causing this hypocretin deficit is still unknown, but is currently thought to be immune-mediated since up to 85–95 % of patients with narcolepsy with cataplexy have the HLA allele DQB1*06:02. Undetectable or low hypocretin-1 levels in cerebrospinal fluid (CSF) are found in 95 % of narcoleptic patients with cataplexy. Hypocretins are neuropeptides that have a central role in the control of alertness. Symptoms usually begin in adolescence, 1,4 and they are the result of hypocretin deficiency. Clinically, it is characterized by excessive daytime sleepiness (EDS), cataplexy, hypnagogic/hypnopompic hallucinations and sleep paralysis, as well as other sleep disturbances, such as sleep fragmentation. Narcolepsy with cataplexy (narcolepsy type 1) is a chronic neurological disease with an estimated lifetime prevalence of 2.5–5 per 10.000 people. Our results suggest that narcolepsy with cataplexy is not an unrecognized disease in adult patients with schizophrenia or schizoaffective disorder. Five of these 24 were HLA DQB1*06:02 positive, and three of these five subjects underwent lumbar puncture showing normal hypocretin-1 levels. Of those, 24 patients were evaluated by a sleep specialist. On the screening questionnaire, 17 patients had an ESS score ≥11 without cataplexy, 15 had cataplexy-like symptoms with an ESS score < 11, and four had an ESS score ≥11 plus cataplexy-like symptoms. CSF hypocretin-1 determination was proposed to those who were HLA DQB1*06:02 positive. Those who screened positive were assessed by a sleep specialist, and offered an HLA determination. We screened 366 consecutive patients with schizophrenia or schizoaffective disorder with a sleep questionnaire and the Epworth Sleepines scale (ESS) exploring narcoleptiform symptoms. The aim of this work is to assess the frequency of narcolepsy with cataplexy in a large consecutive series of adult patients with schizophrenia and schizoaffective disorder. There are several case reports of patients with narcolepsy and schizophrenia, but a systematic examination of the association of both disorders has not been done.
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