A prolonged severe intoxication after ingestion of phenytoin and phenobarbital.

trol subjects,20 we have seen a clear relationship between pubertal development (Tanner stage) and increased daytime sleepiness in the absence of any changes in total nighttime sleep. Multiple sleep latency test scores showed a significant increase in daytime sleepiness at Tanner stages 3 and 4. From these data we have hypothesized that this period of maturation might be a particularly vulnerable stage in the development of narcolepsy. In the present case the signs and symptoms of narcolepsy were first seen at Tanner stage 4, supporting this hypothesis. The findings in this case suggest the possibility of an additive effect wherein a preexisting tendency toward daytime sleepiness and the pubertal augmentation of sleepiness lead to an unequivocally pathological level of sleepiness.

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