What Is Involved in a Diagnosis of Narcolepsy?

The prevalence is reported differently in surveys conducted in many different races and countries. In a cohort study in Finland, 13,888 identical and fraternal twins were surveyed, and clinical visits and laboratory tests were performed on all 75 people who responded that they may have narcolepsy, 5 of whom Polysomnography. Sleep monitoring finally found three cases of narcolepsy with cataplexy, resulting in a prevalence of 0.026%. Another telephone survey of 4,972 people in the UK revealed a prevalence of 0.04%. A survey of 18,980 individuals in five European countries (UK, Germany, Italy, Spain, and Portugal) shows that the prevalence of narcolepsy is 0.047%, of which the severity is 0.026%, moderate 0.021%. A study in Hong Kong, China reported a prevalence of 0.034%. According to the current data, narcolepsy may be more common in Japan, and a study based on the Japanese population concluded that the prevalence rate was 0.16%. It is rare in Israel, with a prevalence of only 0.02%. But both studies only used questionnaires and interviews, and did not use modern methods such as polysomnography to confirm the diagnosis. A survey conducted in the US state of Nisuda reported that the incidence of narcolepsy was 1.37 / 10000 / year (male 1.72, female 1.05), with the highest incidence in the 20s and subsequent Decreasing. ^[1]

Wang Yuping	(Chief physician)	Department of Neurology, Xuanwu Hospital, Capital Medical University
Li Ning	(Deputy Chief Physician)	Department of Neurology, Xuanwu Hospital, Capital Medical University

Narcolepsy is a chronic sleep disorder of unknown cause. It is clinically characterized by irresistible short-term sleep attacks, which are more common than children or adolescents. Often accompanied by other symptoms such as sudden onset, sleep paralysis, sleep hallucinations, collectively referred to as narcolepsy tetrad. The term narcolepsy was first coined by Gelineau in 1880, so it is also called Gelineau syndrome.

Western Medicine Name

Narcolepsy

English name

narcolepsy

Affiliated Department

Internal Medicine-Neurology

Contagious

Non-contagious

Narcolepsy epidemiology

The prevalence is reported differently in surveys conducted in many different races and countries. In a cohort study in Finland, 13,888 identical and fraternal twins were surveyed, and clinical visits and laboratory tests were performed on all 75 people who responded that they may have narcolepsy, 5 of whom Polysomnography. Sleep monitoring finally found three cases of narcolepsy with cataplexy, resulting in a prevalence of 0.026%. Another telephone survey of 4,972 people in the UK revealed a prevalence of 0.04%. A survey of 18,980 individuals in five European countries (UK, Germany, Italy, Spain, and Portugal) shows that the prevalence of narcolepsy is 0.047%, of which the severity is 0.026%, moderate 0.021%. A study in Hong Kong, China reported a prevalence of 0.034%. According to the current data, narcolepsy may be more common in Japan, and a study based on the Japanese population concluded that the prevalence rate was 0.16%. It is rare in Israel, with a prevalence of only 0.02%. But both studies only used questionnaires and interviews, and did not use modern methods such as polysomnography to confirm the diagnosis. A survey conducted in the US state of Nisuda reported that the incidence of narcolepsy was 1.37 / 10000 / year (male 1.72, female 1.05), with the highest incidence in the 20s and subsequent Decreasing. ^[1]

Causes of narcolepsy

The pathogenesis is not yet clear, which may be related to the decrease in the function of the ascending activation system of the brainstem reticular structure or the hyperfunction of the caudate caudate reticular nucleus.

The cause is unknown, but it can be found to be related to genetics, environmental factors and certain central nervous diseases. Little is known about the environmental factors that may induce narcolepsy. The literature reports include head trauma, changes in sleeping habits, mental stimulation, and viral infections. The relationship between narcolepsy and genetics has been a hot topic in recent years. About 8% -10% of narcolepsy patients have a family history, and the immediate relatives of patients are 10-40 times more likely than the control group; 25 % -31% of single egg twins suffer from narcolepsy, suggesting that genetic factors play an important role in their onset. The HLA allele DQB1 * 0602 has a high positive rate in patients with narcolepsy, reaching 88% -100%.

In recent years, the relationship between orexin and narcolepsy has been remarkable. Orexin is a neuropeptide produced by neurons in the hypothalamus and plays an important role in coordinating the sleep-wake cycle. Orexin-A and orexin are known -B two, orexin-B is closely related to the disease. Experiments have shown that orexin-deficient mice have narcolepsy-like sleep disorders. Nishino et al. Confirmed that the oresin content of cerebrospinal fluid was significantly lower in patients with narcolepsy, which provided evidence for the causal relationship of orexin deficiency in the brain. In the brain tissue of patients with narcolepsy after death, it was found that the efficacy of orexin-producing neurons was significantly reduced, suggesting that the decrease in the number of neurons that produce orexin is closely related to narcolepsy.

The narcolepsy of narcolepsy is due to the decrease in activation signals of dorsal raphe nuclei and blue spots transmitted by orexin neurons. Reduce the activity of awakening neurons in the lateral part of the pontine tectum and the nucleus of the foot (LDT / PPT), reduce the inhibition of neurons that trigger abnormal rapid eye movement sleep, and make the abnormal rapid eye movement phase earlier or in inappropriate conditions Appears below. On the other hand, because orexin neurons reduce the activation signal to monoaminergic neurons, the latter inhibits the hypothalamic ventrolateral preoptic region (VLPO) neurons from being inhibited, and it appears non-rapid when it should not. Eye movement sleep with reduced arousal.

Peyron et al. Found that neurons that produce melanin agglutinin (MCH) are distributed in the lateral part of the hypothalamus, and are closely mixed with neurons that produce orexin, and there is no overlap between the two. Combining narcolepsy with a strong human leukocyte antigen allele, Siebold et al. Speculated that the occurrence of narcolepsy is related to the hypothalamic orexin neurons being subjected to immune attacks mediated by DQBI * 0602 restricted T cells.

In summary, narcolepsy is a disease that is genetically susceptible, affected or triggered by environmental factors. The pathogenesis is related to changes in sleep structure function and abnormal neurotransmitter function. It is also related to the destruction of the hypothalamus-producing neurons by DQBI * 0602-restricted T cell-mediated autoimmune responses. Secondary or symptomatic narcolepsy is more common after brain trauma, other tumors of the brain stem, and granulomas of the hypothalamus.

Narcolepsy classification

The second edition of the International Classification of Sleep Disorders (ICSD-2) classifies narcolepsy into four subtypes:

(1) narcolepsy with cataplexy;

(2) narcolepsy without cataplexy;

(3) due to narcolepsy and medical conditions;

(4) narcolepsy (to be classified).

Clinical manifestations of narcolepsy

There was no significant difference in the prevalence of men and women. Most cases started after the age of 10, and about 5% were before the age of 10. The age of onset can vary from early childhood to the fifties. There are two peaks during this period, the larger one being around 15 years old and the other being around 36 years old.

Narcolepsy excessive daytime sleepiness

It is mainly manifested by irresistible short sleep episodes during the day, which often occur 3-4 hours after waking up. Although they try to stay awake during the episodes, they cannot control themselves, and soon go to sleep. Sleep usually lasts for several minutes and can occur daily repeatedly. Regardless of time, place and activity. Although sleep episodes often occur when the environment is monotonous and normal people will fall asleep, they can also occur in dangerous situations (such as driving, crossing roads, dangerous operations at high altitudes, etc.). After waking up, I feel energetic and clear-headed. If I prevent him from falling asleep, he will be irritable. Can wake up a few minutes later and suddenly fall asleep.

Although there are frequent sleep episodes during the day, the total sleep time of the patient usually does not increase. It can be observed in the EEG recording that the rapid eye movement sleep period (REM) is immediately entered from the beginning of the onset, and the normal rapid eye movement Non-rapid eye movement sleep precedes sleep, and usually lasts 60-90 minutes. Patients' night sleep is often unsatisfactory and can be interrupted by vivid and terrible dreams.

Narcolepsy

It appears as a sudden involuntary bowing or a sudden fall to the ground, but the consciousness is always clear, usually lasting only a few seconds, usually only once a day. Sudden falls are caused by a transient loss of partial or systemic muscle tone.

Sudden falls are seen in 65% -70% of patients with narcolepsy, which is one of the characteristic manifestations of narcolepsy. Usually caused by emotional stimuli, such as laughter, anger, excitement, etc. The patient may suddenly fall with knee weakness; or suddenly lose muscle tension in the head and lean forward or lower his head; or suddenly lose facial muscle tension, resulting in expressionless expression and blurred speech. These three clinical manifestations are the most common symptoms of cataplexy. The onset time is usually less than one minute, and he is conscious, without memory impairment, breathing is intact, and recovery is complete. These episodes are similar to the loss of muscle tone that occurs during REM sleep, or, to a lesser extent, to what a normal person would do when "laughing and laughing".

Narcolepsy hallucinations before falling asleep

It is manifested as a vivid dream-like experience before falling asleep or before awakening. Hallucinations are the most common, and hallucinations and hallucinations can also be seen.

Pre-sleep hallucinations and post-wake hallucinations are seen in 12% -50% of patients with narcolepsy. Patients can experience vivid, often unpleasant sensory experiences, including visual, tactile, sports, or auditory, before or when they wake up. It can be expressed as a dream-like experience, such as seeing athletes and people walking around the stadium. Common hallucinatory experiences include being at the scene of a fire, being attacked, or flying in the air. These hallucinations are very vivid, mostly nightmares that occur during awakening and sleep transitions, with occasional general paralysis, oppression, and fear. Patients often recount that these hallucinations are more terrifying than ordinary dreams, because such dreams come from a real (waking) environment, and it is difficult to distinguish between real states and dreams.

Narcolepsy sleep paralysis

Sleep paralysis, also known as sleep paralysis, occurs in 15% -34% of narcolepsy patients. Sleep paralysis is a horrible experience of transient dysphoric patients who wake up from sleep and have transient body inability to speak or speak, and only breathing and eye movements are not affected. Sleep paralysis can last from a few seconds to several minutes, and often occurs simultaneously with bedtime hallucinations and wakeful hallucinations, so this feeling of fear is enhanced. The vast majority of patients can be stopped by other people's calling and pushing, and individual patients cannot wake up. Sleep paralysis is similar to the exercise suppression associated with rapid eye movement sleep, and is also common in normal children and some other normal adults.

Narcolepsy

About half of the patients have auto-symptoms. In the case of seemingly awake, the patients have awakening and sleep phenomena that coexist or rapidly change. For example, some untimely talking behaviors, long-distance driving without purpose, or even shoplifting, etc., last for several seconds and one hour Or longer, completely forgetting what happened afterwards.

Narcolepsy insomnia

Many patients are accompanied by insomnia, which may cause intermittent sleep at night due to frequent hallucination hallucinations or sleep paralysis, and it is not possible to catch daylight; it may also be because of the excessive sleepiness during the day, which interferes with night sleep. Patients with narcolepsy have a total sleep time of 24 hours a day, which is not longer than that of normal people.

Narcolepsy other

Memory loss, palpitations, general weakness, depression, anxiety, etc.

Narcolepsy diagnostic criteria

1. Have complaints of drowsiness or sudden muscle weakness;

2. Napping or going to sleep during the day and night, recurring almost every day, for at least 3 months;

3. Mood-induced sudden bilateral postural tensity loss (cataplexy);

4. Accompanying features: sleep paralysis, pre-sleep hallucinations, autonomic behavior, frequent awakening at night;

5. Polysomnography (PSG) shows one or more of the following characteristics: sleep latency <10min; REM sleep latency <20min; multiple sleep latency tests (MSLT) average latency <5min; 2 sleep initiations REM sleep;

6, HLA typing showed DQBI * 0602 or DR2 positive;

7, clinical symptoms can not be explained by other physical and mental illness;

8. Other sleep disorders, such as PLMD or central sleep apnea, may not be the main cause of symptoms.

All of the above 8 items meet the 2nd and 3rd items, or the 1st, 4th, 5th, and 7th items can be diagnosed.

Differential diagnosis of narcolepsy

Narcolepsy

The symptoms of this disease are similar to those of narcolepsy, but the onset of daytime sleep is not difficult to resist. There are no other accompanying symptoms. It lasts longer after falling asleep, and the day and night sleep time are significantly increased. It is the normal REM sleep latency, and the REM sleep latency of narcolepsy is shortened. In MSLT, the sleep latency of this disease is less than 10 minutes, the initial sleep REM cycle is less than 2 times, and the narcolepsy sleep latency is less than 5 minutes. The REM cycle is more than 2 times.

Kleine Levin Narcolepsy Kleine-Levin syndrome

Kleine-Levin syndrome, or periodic drowsiness of adolescent bulimia, is a rare and unexplained episodic disease, manifested as cyclical excessive sleep, which can last from several days to 1 week, and a few to several weeks. . Accompanied by good hunger and more food, eat 5 times more than normal people, often after the wake up, excitement, agitation, impulsive behavior and other mental symptoms, can occur 3-4 times a year. Onset is mostly in the age of 10-20 years, and there are many males, who can heal themselves in adults. At present, the etiology and pathogenesis of this disease are unclear, and may be caused by abnormal function of the midbrain, especially the lower thalamus or focal encephalitis.

Narcolepsy complex partial seizures

Because about 50% of patients with narcolepsy can develop automatic behavior and forgetfulness, they are easily misdiagnosed as epilepsy. Epilepsy has no uncontrollable sleep and sudden onset, and polysomnography is helpful for identification.

Narcolepsy syncope

Transient loss of consciousness due to cerebral blood circulation disorders. Many dizziness, weakness, nausea, dark eyes and other short-term threats, followed by loss of consciousness and fainting. It is often accompanied by autonomic nerve symptoms, such as pale, cold sweats, weak pulses, and decreased blood pressure, which last for a few minutes. ^[2]

Narcolepsy treatment

Narcolepsy western medicine treatment

(I) Treatment of excessive drowsiness

1. Central stimulant: it has an activating effect on the reticulate activation system and exerts a strong excitement effect. Is an effective drug for the treatment of sleep attacks. Stimulants have a tolerance period of 6-12 months. Therefore, the treatment needs to be stopped periodically to achieve the desired effect. These drugs can promote the release of presynaptic monoamine neurotransmitters (NE, 5-HT, DA), inhibit their reuptake, and enhance the excitatory effect of orexin on the brain stem ascending reticular activation system. May improve arousal.

(1) Amphetamine: The usual dose is 20mg daily, orally. The initial dose of 5mg, 2 times a day, can effectively reduce daytime sleep. This drug has many adverse reactions, such as headache, excitement, anxiety, inability to sit still, nighttime sleep disturbance, tachycardia, hypertension, nausea and vomiting. Cardio-cerebrovascular disease, hypertension, epilepsy, liver and kidney dysfunction are disabled.

(2) Methylphenidate: short half-life, the commonly used dose is 10-30mg orally daily, divided into 2-3 times. Adverse reactions were headache, dry mouth, upset stomach, sweating, and difficulty urinating. Hypertension and epilepsy should be used with caution.

(3) Maindole: The effect is weaker than amphetamine, which can reduce daytime sleep onset. The oral dose is 0.5 mg once daily, taken before meals. The maximum daily dose does not exceed 1.5 mg. The drug is less addictive and the adverse reactions are gastrointestinal reactions and sympathomimetic symptoms.

(4) Pimoline: similar in structure to methylphenidate, with a longer half-life (12-17 hours), slow onset, good tolerance, and weaker efficacy than methylphenidate hydrochloride. The dose is 60-200mg per day, which has a moderate arousal effect on most patients. Adverse reactions include loss of appetite, headache, dry mouth, and upset stomach. A few cases have severe liver damage and should be used with caution.

2 . Modafinil, a new type of central stimulant: Modafinil is a new wake-up drug approved by the US FDA for the treatment of narcolepsy. This medicine does not directly promote the release of NE or DA. It may activate the hypothalamic awakening center and excite the hypothalamic orexinergic neurons to achieve wakefulness. The effective daily dose is 200-400mg, the peak concentration is reached 2-3 hours after oral administration, and the half-life is about 10-12 hours. Long-term use can still maintain the effect. Modafinil can combat psychomotor disorders caused by sleep deprivation and improve cognitive function. It has no effect on the start, maintenance, awakening and sleep composition of night sleep, nor does it affect early morning behavior and daytime nap. One of the drugs of choice.

3 Other drugs: Because narcolepsy is related to the metabolism of DA, narcolepsy can be treated by increasing presynaptic DA levels.

(1) Selegiline: An irreversible monoamine oxidase B (MAO-B) inhibitor that enhances its function by reducing the metabolism of DA. When the daily dose is 20-30mg, it can significantly inhibit REM sleep and improve arousal levels. Adverse reactions were excitement, headache, insomnia, dry mouth, sweating, and tremor. The drug has the dual effects of improving awakening and anti-cataplexy.

(2) Bupropion: Blocks the effect of presynaptic DA reuptake, can increase the content of DA in nerve endings, and has a good effect in treating narcolepsy. The dose is 100 mg daily and taken in 3 times. The adverse reaction was occasional seizures.

(B) the treatment of cataplexy

1 . Noradrenergic drugs: reversible cataplexy attacks, such as dixipramine, viloxacin, and venlafaxine, are effective in combating cataplexy. Venlafaxine is the drug of choice, with a dose of 25-50 mg daily orally.

2 . Tricyclic antidepressants: It can increase the content of monoamines such as NE in the blood. It is a commonly used anti-quenching drug, such as imipramine (25-200mg), chlorpromazine (10-200mg per day), and prolo Tilin (5-60mg daily) and so on. SSRIs, such as fluoxetine, are also effective for sudden onset attacks.

3 Sodium oxybate: It is a derivative of GABA, with a peak time of 40 minutes and a half-life of 53 minutes. After 1 week of treatment, the incidence of sudden onset is reduced by 53%, and after 4 weeks, it is reduced by 69%. Symptoms and hallucinations also improved to some extent.

(Three) treatment of insomnia

If patients use stimulants during the day, they may experience insomnia or restlessness during the night. At this time, short-half-life hypnotics, such as zolpidem, should be taken orally before bedtime. Try to avoid giving long-half-life hypnotics to prevent daytime sleepiness. Heavier.

Chinese medicine treatment of narcolepsy

(1) Both Heart and Spleen Deficiency

1. Symptoms of drowsiness, dazzling phantoms before going to bed, dizziness, bleak complexion, thin white fur, and weak veins.

2 . Governing law replenishes the heart and spleen.

3 Recipe Guigui Decoction.

If you have bloating, stuffiness, poor appetite, and greasy tongue, add Poria, Pogostemonia, Magnolia, to aromatize and dampen the spleen and breathe. Those who have more phantoms before going to bed due to insufficient heart yin, add Ophiopogon, Yuzhu, North Sand Ginseng.

(Two) weak temper

1 . Symptoms are drowsy all day long, pale, languid, lazy, insomnia, dreams, shortness of breath, forgetfulness and panic, pale tongue, thin white tongue coating, and weak pulse.

2 . Governing law replenishes qi and blood, and refreshes the mind.

3 Recipe Yangxin Decoction

Such as stop drinking water, heart palpitations, add Poria, betel nut, Zexie; those who are lethargic all day long, add Su Hexiang, Shichangpu, Yizhiren to refresh the mind.

(Three) deficiency of kidney yang

1 . Symptoms of drowsiness, or drowsiness, weak waist and knees, chills, cold limbs, impotence, long urination, nocturnal frequency, pale tongue, thin white tongue coating, and weak pulse.

2 . Governing method warm kidney yang.

3 Recipe Yougui drink addition and subtraction.

If qi deficiency, blood loss, etc., add ginseng reuse and add atractylodes and astragalus.

(D) insufficient sea of marrow

1 . Symptoms Laziness and drowsiness, weakness in the waist and knees, dizziness, nausea, or tinnitus and deafness, dull expression, sluggish thinking, poor mentality, memory loss, pale red tongue, thin white tongue coating, weak or thin pulses.

2 . Governing method fills the essence and replenishes the marrow, strengthening the brain.

3 Recipe Zuogui Pills.

Nocturnal emission, dream lover, plus raw oysters, golden cherries, coriander seeds, lotus roots and solid kidney astringent essence; hot flashes, night sweats, dry mouth to dogwood, deer carapace, add Zhimu, cork nourishing yin and fire.

(5) Lack of Heart Yang

1 . Symptoms: sleepiness, malaise, chills, cold limbs, pale complexion, pale tongue, thin white fur, and thin pulses.

2 . Governing method warms up the heart and yang.

3 The prescription Guizhi Gancao Decoction is combined with Ginseng Yiqi Decoction.

For those who have cold chills, go to cinnamon sticks, add cinnamon and dried ginger to supplement the fire to help the yang, and warm the meridians; those with pale blood deficiency, add Ejiao, Shudi, Chinese wolfberry, and Polygonum multiflorum tonicate the blood.

(6) Bile-heat Phlegm Resistance

1 . Symptoms: drowsiness, dizziness, bitter mouth, dry mouth, vomiting, chest tightness, red tongue, yellow fur, and pulse count.

2 . Governing method clears biliary and phlegm.

3 Recipe Artemisia Root Qingdan Decoction.

Due to the internal resistance of phlegm turbidity, Qi reversal does not decrease, see those who are hard in the heart, and the qi is not removed. Add the spiral soup to replace Qi soup to benefit the qi and stomach, and reduce phlegm and qi. If you are not awake, you can add Angong Niuhuang Wan to wake up. Brain opening.

(VII) Severe Heat and Injury

1 . Symptoms: drowsiness, lethargy, limbs drowsiness, appetite, full chest, heat and spontaneous sweating, headache, thirst, loose stools, short urination, greasy tongue, and pulse deficiency.

2 . Governing Law Qingshu Yiqi.

3 Recipe Qingshu Yiqi Decoction.

If the heat is worse, add gypsum; those who are wet and turbid can see that the tongue is white and greasy, go to Ophiopogon japonicus and Zhimu, add patchouli and grass bean pimple.

(Eight) spleen dampness and liver depression

1 . Symptoms Frequent drowsiness, dull head, mental stupefaction, heavy limbs, fatigue, fatigue, heavy menstrual flow, purple patches, low back pain, excessive leucorrhea, cough, sputum, dizziness, headache, or noisy stomach, tired face Obscure, poor memory, dry yellow, red tongue, thick and greasy white fur, heavy pulse.

2 . Governing method is to strengthen the spleen and liver, dehumidify and refresh the brain.

3 The prescription is finished with decoction.

If you have more leucorrhea, add squid bone, coriander, and calcined oyster to stop the astringency; if you have more cough and sputum, add Pinellia terrestris and Tiannanxing.

(9) Wet turbid spleen

1 . Symptoms of drowsiness frequently, dull head, mental fainting; heavy limbs, fatigue, fatigue, dullness, dullness, dullness, pale tongue, thick white and greasy tongue coating, slow or slippery pulses.

2 . Governing the spleen and dampness, refreshing consciousness.

3 Prescription Pinellia Baizhu Tianma Decoction.

If the wet phlegm is too rich and the tongue is white and slippery, add Zexie and Guizhi to moisten the drink; if the liver yang is too high, add hook rattan, mother of pearl, and substitute ocher to breathe the wind.

(10) Blood Stasis Block

1 . Symptoms of drowsiness, long delay, fatigue, dizziness, memory loss, headache, insomnia, dreams, dark purple tongue, often petechiae or petechiae, weak pulse.

2 . Governing the law, activating qi and activating blood, opening up the consciousness and benefiting the brain.

3 Recipe Tongqiao Huoxue Decoction.

If you have a headache, you can add Pueraria root, Yan Husuo, etc .; if you have stasis and blood convulsions, add silkworm, whole scorpion, and tadpole.

Acupuncture treatment of narcolepsy with Chinese medicine

1 . Body needle

(1) Method 1

Main point: Nasal sex.

Acupoints: Shenmen, Sanyinjiao, Taichong.

Operation: Take Bijiao acupoint, pierce 0.6--0.9cm towards the tip of the nose, and leave the needle after the needle feels. Then take bilateral Shenmen, Sanyinjiao, and Taichong acupoints, apply twisting and lifting techniques, and leave needle 1 Every 20 minutes, repeat the twisting and lifting technique for bilateral Shenmen, Sanyinjiao, and Taichong acupoints. Once a day, 5 times is a course of treatment.

(2) Method 2

Main points: Shen Mai, Zhao Hai.

Acupoints: Baihui, Sanyinjiao.

Operation: According to the treatment principle of "insufficient yang, more than yin, when yang is given first, and then diarrhea", take the Shenmai acupoint, insert the needle to a depth of 3 cm, and twist the tonic method with a small amount. Manipulate for 1 minute. Then acupuncture at Baihui, Zhaohai, and Sanyinjiao points, and acupuncture and acupuncture, and acupuncture for 30 minutes, once a day.

2 . Scalp

Main acupuncture points: national standard acupuncture midline, forehead midline.

Acupoints: Wet and spleen spleen plus second line (double) and forehead band; those with deficiency of heart and spleen, plus first line (right) and second line before forehead; those with insufficient kidney yang, add third line (double) for forehead , The midline on the pillow, the lateral line on the pillow (double); those with insufficient bone marrow, increase the lateral line on the forehead (double).

Operation: flat puncture. For those with wet and spleen spleen, the top midline and the second frontal line should be pumped (diarrhea), and the frontal midline should be pumped (tonic); Qi method, the rest using air intake method: when the needle is left, it is required to do proper whole-body activities to invigorate yang. When performing acupuncture on the wet and spleen spleen and the heart and spleen, massage the abdomen and take a deep breath. For those with insufficient kidney yang and insufficient marrow sea, the acupuncture can be used to moxibust the abdomen, and the needle can be used to warm the acupuncture midline.

3 Warm acupuncture

Acupoint selection: Tongli, Dazhong, Xinyu, Pishu.

Operation: This method is performed with a body needle. Cut ordinary moxa rolls into moxa segments of about 20cm. After the needle is filled with gas, Fan cut a round piece of paper with small holes on the needle body to cover the skin, and then cover the moxa segment on the needle handle. Ai Duan is about 2 cm away from the skin. Ignite the top of Ai Duan. After it burns out, moxibustion is performed as usual. Each acupoint is 2-3 strong, 1 time a day, 7 times a course of treatment.

4. Auricular acupoints were taken from Shenmen, brainstem, subcortex, small occipital nerve points, liver, spleen and heart points. Ask the patient to gently rub the auricle on one side for 4 minutes, wipe the auricle with a 75% alcohol cotton ball, place 1 Wang Wangliuzi on a 0.5cm x 0.5cm tape, and stick it to the above points, only one side at a time The left and right ears alternate. Instruct patients to press the acupressure points 3-4 times a day for 5 minutes each time. The degree of compression is tolerated by the patient, and the pills are pressed once every 2 days.

Narcolepsy massage therapy

Adopting the cyclical release therapy. Ask the patient to take a prone position, relax and breathe smoothly. The surgeon is located on the right side of the patient, and uses the thumb, forefinger, middle and ring fingers of both hands to operate on the patient's surface.

Method: The skin and subcutaneous tissue were pinched from the Changqiang acupoint at the crotch of the crotch, and then slowly transported to the Baihui acupoint along the governing vein, and then transported to the Tianzhu acupoint from the Zhibian acupoint through the armpits; In addition, the Yangbai acupoint starts from the bile meridian to the shoulder well acupoint, and then loosens the soft tissues along the scapula, lateral waist, and sacrum with lifting muscles and shaking. The entire technique must be completed consecutively, and the priority of the technique must be properly applied according to the patient's tolerance. After treatment, it is better that the patient feels numbness in the head, shoulders and back, and thermal comfort. Once a day, 10 times is a course of treatment.

Narcolepsy psychotherapy

1 . Some patients with narcolepsy have symptoms of reactive depression. The patients should be given psychological support to enhance their confidence in treatment and gain the understanding and support of family and colleagues.

2 . Behavioral therapy: Change your original lifestyle.

3 Reasonably arrange your work and rest time, emphasize regular work and rest, and try to ensure that you get enough sleep at night. Avoid emotional excitement and excessive tension. Increase physical activity during the day to improve excessive daytime sleepiness.

Narcolepsy prevention

1. It is very necessary to take a series of preventive measures in daily life to reduce the outbreak. Patients should consciously arrange a rich and colorful life, participate in cultural and sports activities, do interesting work, and try to avoid monotonous activities. Drink tea or coffee during the day to increase brain excitement.

2. Maintain an optimistic mood, build confidence to overcome disease, and avoid depression and sadness, but you should not be overly excited. Because the loss of excitement can induce sudden onset.

3. It is best not to travel alone, do not engage in high-altitude and underwater operations, and do not engage in driving vehicles, managing various signals and other tasks with great responsibility to avoid accidents.

4. Patients with narcolepsy should try to avoid taking sedative drugs, so as not to increase the incidence.

Narcolepsy prognosis

Some patients with adolescent onset can also gradually recover or alleviate symptoms with age, and most of those with adult onset continue for life.