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The two faces of narcolepsy: What are the differences between multi-symptom and mono-symptom?
Idiopathic Hypersomnia (IH) is a neurological disease characterized by excessive sleep and excessive daytime sleepiness (EDS). Since Bedrich Roth first described the disorder in 1976, narcolepsy has been divided into two main forms: polysymptomatic and monosymptomatic. The two forms differ significantly in clinical presentation, and understanding these differences is critical for proper diagnosis and treatment.
According to current research, multi-symptomatic patients show a variety of symptoms, such as sleep inertia and mental confusion, while mono-symptomatic patients are mainly concentrated in irrepressible daytime sleepiness.
Symptoms of multisymptomatic and monosymptomatic types
People with multisymptomatic syndrome experience a range of symptoms, including but not limited to: excessive daytime sleepiness, pronounced sleep inertia, mental fogginess, and prolonged sleep without restorative effects. Additionally, these patients may experience symptoms related to the autonomic nervous system, such as palpitations, digestive problems, and difficulty regulating body temperature.
In contrast, monosymptomatic patients may only show intense daytime sleepiness without a variety of additional symptoms. This makes it easier for them to ignore their condition and fail to get a timely diagnosis in their daily lives.
Even when excessive sleepiness occurs, monosymptomatic patients often do not experience other physical or psychological symptoms, making their condition difficult to detect.
Diagnostic Challenges
Diagnosing narcolepsy can be challenging, especially because symptoms may coexist in both multisymptomatic and monosymptomatic patients. Each patient's presentation is unique, so clinicians must carefully rule out other possible causes of daytime sleepiness, such as sleep apnea. Doctors usually use subjective rating scales and objective tests to assess daytime sleepiness.
"Even when other specific causes of hypersomnia are present, the contribution of these causes to excessive sleepiness must be carefully assessed."
Differences in treatment options
The two types also have different treatment needs. Multisymptomatic patients often require a comprehensive assessment to develop a treatment plan for multiple symptoms simultaneously, which may require the use of multiple types of medications, including stimulants and non-stimulants. The monosymptomatic type may only need to focus on improving daytime sleepiness symptoms, and the medication required may be relatively simple.
Currently, the FDA-approved narcolepsy drug "Xywav" has become one of the main treatment options and is effective for patients with multi-symptom syndrome.
Future Research Directions
Although several studies have explored narcolepsy, many related biomarkers and specific causes still require further study. In-depth investigation of monosymptomatic patients, in particular, may help identify the cause and update treatment methods in the future.
Based on current understanding, there are significant differences in symptoms, diagnostic challenges, and treatment strategies between the two, so in the future, will people have a deeper understanding of these differences to help them make decisions about your treatment? To get more effective treatments?
