What’s the Diagnosis?
by Rachel Kosciusko
“Yes, I appreciate the call. I will sit down with her as soon as she gets home.”
Brandy’s mother hung up the phone and sank down in her chair. Her mind was racing. Brandy was suddenly tired all the time? She had fallen asleep in the middle of her trigonometry class? The guidance counselor had suggested she drop cheerleading for a while to get back on track, but Brandy would never go for that. She was a star student! This had never been a problem before.
Brandy wandered into the kitchen and found her mom wrinkling her forehead at her. “I got a call from your school today. You fell asleep in math class?”
“I just have a lot going on!” Brandy said. “It’s no big deal, kids fall asleep all the time.”
But Brandy continued to have problems at school. Her grades suffered and her teachers were repeatedly waking her up. After another call from the guidance counselor, Brandy’s mother decided it was a situation that needed to be addressed.
The family doctor was concerned as well when Brandy’s mother dragged her daughter in for a check up after school. “Have you had any recent head trauma? A fall at cheer practice perhaps?” asked the doctor. Brandy shook her head.
The family doctor took Brandy’s temperature. No fever. Her lymph glands weren’t swollen either. Brandy denied having any headaches. She only said that she gets “super drowsy” from time to time. Brandy and her mother both agreed that there had not been any major changes in her eating habits or mood.
The following Friday night, Brandy was cheering at her high school’s football game. As her team scored the winning goal, Brandy joined in on the celebration and began to storm the field with her teammates. Suddenly, her head went cloudy. Her legs felt wobbly – the cheering and the band music began to fade out.
“Brandy? Do you know what day it is?” prompted the paramedic, trying to get an idea of her mental status. “It’s Friday. I was cheering at the game, and I was running on to the field when I guess I passed out.”
Brandy’s mom craned her neck from the front passenger’s seat of the ambulance. Her daughter was still conscious, as the EMT began to record his report. “Chief Complaint: Syncope,” he typed. He looked at the young girl in her school cheerleading uniform. She looked very confused, and a little scared. “PT states she collapsed while cheering for her school’s winning football team,” he typed in the description box as an afterthought. An hour later, the ER physician mulls over this note and has an idea.
What’s wrong with Brandy?
Brandy has narcolepsy. Narcolepsy is a life-long chronic disease characteristic of
excessive daytime sleepiness. The chief cause of narcolepsy is a deficit in orexin, a neurotransmitter synthesized in the lateral hypothalamus. Orexin functions throughout the day to maintain a steady level of arousal neurotransmitters, and to inhibit the REM-on sleep area of the brain. When an individual has narcolepsy, there is not enough orexin to keep them awake throughout the day. Furthermore, during times of high emotional energy, the amygdala will stimulate the REM-on region ofthe brain. Without enough orexin to inhibit this stimulation, the person with narcolepsy may collapse during emotionally charged situations, and immediately fall into REM sleep.