Narcolepsy in a 4-Year-Old

Narcolepsy is a disabling neurodegenerative condition that is characterized by the hallmark of excessive daytime sleepiness. Diagnosis of narcolepsy can be difficult in all aged patients, but especially so in children less than 5 years old. We present a unique case of a 4-year-old girl who presented with slurred speech, behavioral changes, and hypersomnolence. After a thorough evaluation, she was diagnosed with narcolepsy type 1. We provide a literature review about this diagnosis and discuss the signs, symptoms, and workup, with a focus on the challenges associated with determining the definitive diagnosis. The role of obtaining cerebrospinal fluid hypocretin-1 levels in the diagnostic evaluation of patient with suspected narcolepsy is emphasized.