MEDICAL REPORT
"Three years old boy presented with excessive sleep, about 18 hours a day for more than a month. The patient slept during sitting and could not resist it. It was difficult to arouse by mother. There was also history of inability to sit erect and get repeated attacks of posture loss. In addition some abnormal movement of hands during sleep for a few minutes. After waking the patient is alert but soon after become lethargic and goes to sleep withen 2-3 hours. He sleeps during the night. There was no history of fall, trauma and seizure like behavior during wake.
The examination was normal. Several investigations were done including Video EEG and Polysomnography. CBC, Glucose, Bone Profile, UE, LFT, Ammonia, Lactate, Blood Gas were all normal. TFT was normal. Routine EEG was normal. MRI Brain was normal 24 hour video. No epileptic waves seen during the study.
Polysomnography suggestive of narcolepsy.
The child was started on Methylphenidate and Imipramine, as Sodium Oxybate was not available. There was remarkable improvement. Excessive sleep and cataplexy stopped. However, new findings were noted. The child became in between withdrawn and speech output was decreased. He would play and react with other children. On history it was found that the boy had from beginning the delayed speech and poor interactions with the children.
At present the child was on Imipramine 10 mg a day and Methylphenidate 5 mg twice a day. It was planned to sent the report outside Oman for a consultation. Meantime parents approached for a medical report. In last outpatient visit Dermatologist opinion was sought for possible scabies. Emovate Plus Eurax was advised on the Dermatologist advice."










