Question

A 16-year-old boy is brought to the pediatrician by his mother because of excessive daytime sleepiness. She states that over the past six months she has received numerous phone calls from the boy’s school informing her that her son sleeps throughout all of his afternoon classes and is often difficult to arouse at the end of class. The patient reports that occasionally when he wakes up in the morning he cannot move for extended periods. He says that sometimes when he laughs at jokes or be-comes nervous before a test, he feels as if he cannot move his legs. He admits that he has even fallen to the floor because of leg weakness while laughing. Which of the following is the best choice for treating this patient?

(A) Chloral hydrate

(B) Hydroxyzine

(C) Modafinil

(D) Prochlorperazine maleate

(E) Zolpidem

Answer 1

The correct answer is C. This patient exhibits some of the classic symptoms of narcolepsy, including daytime sleepiness, cataplexy, and sleep paralysis. Cataplexy is defined as brief episodes of bilateral weakness brought on by strong emotions such as laughing or fear, without alteration in consciousness. Sleep paralysis is an episode of partial or total paralysis that occurs at the beginning or end of a sleep cycle. Patients are often aware that they are awake, but may suffer from frightening hallucinations known as hypnagogic when they occur at sleep onset, and hypnopompic when they occur on awakening. Modafinil is an amphetamine derivative used to treat attention deficit/ hyperactivity disorder and narcolepsy. Patients suffering from cataplexy and sleep paralysis may also benefit from the initiation of tricyclic antidepressants or selective serotonin reuptake inhibitors.

Answer A is incorrect. Chloral hydrate is a nonbenzodiazepine hypnotic that is used for sedation and insomnia. This patient does not need help sleeping.

Answer B is incorrect. Hydroxyzine is a nonselective antihistamine that is used in the treatment of anxiety, pruritus, nausea/vomiting, sedation, and insomnia.

Answer D is incorrect. Prochlorperazine maleate is a typical antipsychotic used in the treatment of nausea, vomiting, anxiety, and psychosis.

Answer E is incorrect. Zolpidem is a nonbenzodiazepine hypnotic that is used in the treatment of insomnia.