Misdiagnosis of narcolepsy

BACKGROUND: Narcolepsy is a chronic primary sleep disorder, characterized by excessive daytime sleepiness and sleep dysfunction with or without cataplexy. Narcolepsy is uncommon, with a low prevalence rate which makes it difficult to diagnose definitively without a complex series of tests and a detailed history. The aim of this study was to review patients referred to a tertiary sleep centre who had been labelled with a diagnosis of narcolepsy prior to referral in order to assess if the diagnosis was accurate, and if not, to determine the cause of diagnostic misattribution. METHODS: All patients seen at a sleep centre from 2007–2013 (n = 551) who underwent detailed objective testing including an MSLT PSG, as well as wearing an actigraphy watch and completing a sleep diary for 2 weeks, were assessed for a pre-referral and final diagnosis of narcolepsy. RESULTS: Of the 41 directly referred patients with a diagnostic label of narcolepsy, 19 (46 %) were subsequently confirmed to have narcolepsy on objective testing and assessment by a sleep physician using ICSD-2 criteria. CONCLUSIONS: The diagnosis of narcolepsy was incorrectly attributed to almost 50 % of patients labelled with a diagnosis of narcolepsy who were referred for further opinion by a variety of specialists and generalists. Accurate diagnosis of narcolepsy is critical for many reasons, such as the impact it has on quality of life, driving, employment, insurance and pregnancy in women as well as medication management

Late Cretaceous spore-pollen zonation of the Central African Rift System (CARS), Kaikang Trough, Muglad Basin, South Sudan: angiosperm spread and links to the Elaterates Province

This paper presents a first detailed study on and new zonation scheme for the Kaikang Trough, Muglad Basin of South Sudan. The Kaikang Trough lies within the central sediment locus of the Muglad Basin, a non-marine African cratonic basin within the Central African Rift System (CARS) Two wells, KW-1 and K-4, were examined leading to the recognition of five palynological assemblage zones: K-I (early–middle Cenomanian), K-II (late Cenomanian), K-III (Turonian?–Santonian), K-IV (Campanian–Maastrichtian) and K-V (Maastrichtian). The elaterate group are peculiarly absent in otherwise rich Cenomanian palynological assemblages of the Muglad Basin. Why this is so, and the implications for the global middle Cretaceous Elaterate Province, needs some explanation. The CARS provided a range of diverse freshwater alluvial and lake-shore substrates. Its cross-continent sweep may have played a role in the evolution and dispersal of floras including early angiosperms as the rift basin of the proto-South Atlantic became a permanently flooded fjord