Investigators at University of Bologna and other centers in Italy, Finland, USA, and UK, performed clinical, polysomnographic, and cataplexy-video assessments at diagnosis (mean age of 10 +/- 3 years) and after a median follow-up of 3 years. At diagnosis children with narcolepsy with cataplexy showed an increase of sleep time during the 24 h; at follow-up, sleep time and nocturnal sleep latency shortened. Hypotonic phenomena decreased over time and were age dependent. At onset, childhood narcolepsy with cataplexy is characterized by abrupt increase of total sleep over the 24h, generalized hypotonia and motor overactivity, and hypocretin 1 deficiency. With time, cataplexy evolves into classic presentation (brief muscle weakness episodes triggered by emotions), whereas total sleep time across 24h decreases, returning to more age-appropriate levels. [1]

COMMENTARY. Narcolepsy with cataplexy is characterized by abrupt onset and sudden weight gain that partially remits over time. Childhood onset narcolepsy/cataplexy is more than just a sleep disorder [2]. It is reported in 3 cases in association with paraspinal neuroblastoma [3], and is linked to H1N1 vaccination [4].