COVID-19-Induced Narcolepsy Type I With Cataplexy: A Short Report

Area of Science:

• Neurology
• Sleep Medicine
• Infectious Diseases

Background:

• Narcolepsy Type I is a rare neurological disorder causing excessive daytime sleepiness and cataplexy.
• While COVID-19 is linked to neurological issues, post-COVID narcolepsy is extremely uncommon.
• Orexin (hypocretin) deficiency characterizes Narcolepsy Type I.

Purpose of the Study:

• To report an extremely rare case of Narcolepsy Type I following SARS-CoV-2 infection.
• To highlight the diagnostic challenges and successful treatment of post-COVID narcolepsy.
• To support the hypothesis of viral-triggered autoimmune destruction of hypocretin neurons.

Main Methods:

• Case report of a 42-year-old female with new-onset excessive daytime sleepiness and cataplexy post-COVID-19.
• Diagnostic workup included Polysomnography (PSG) and Multiple Sleep Latency Test (MSLT).
• Cerebrospinal fluid hypocretin levels were measured.

Main Results:

• The patient presented with symptoms within 3 months of confirmed SARS-CoV-2 infection.
• PSG revealed disturbed sleep, while MSLT showed a mean sleep latency of 1 minute with sleep-onset REM periods.
• Markedly reduced cerebrospinal fluid hypocretin confirmed Narcolepsy Type I.
• Treatment with methylphenidate and venlafaxine led to substantial symptomatic improvement.

Conclusions:

• This case adds to the limited literature on narcolepsy following COVID-19.
• It supports the theory that SARS-CoV-2 infection may trigger autoimmune destruction of hypocretin-producing neurons.
• Clinicians should consider narcolepsy in patients with persistent hypersomnolence after COVID-19 for timely intervention.