 Welcome back to our MedSmarter question of the week where we're taking a smarter approach to preparing future physicians. Before we get started, if you'll take just a quick minute and click that like button and also subscribe and turn the bell on so that you'll be notified when we post new videos. Let's get straight to that question. As always, we start with the last sentence of the vignette and then read the rest of the question. Which of the following is the best choice for treating this patient? A 17-year-old girl is brought to the pediatrician by her father because of excessive daytime sleepiness. He states that over the past seven months he has received numerous phone calls from the girl's school informing him that his daughter sleeps through all of her afternoon classes and is often difficult to arouse at the end of class. The patient reports that occasionally when she wakes up in the morning she cannot move for extended periods. She says that sometimes when she laughs at jokes or becomes nervous before a test, she feels as if she cannot move her legs. She admits that she has even fallen to the floor because of leg weakness while laughing. Which of the following is the best choice for treating this patient? Take a look at the answer choices, come up with your answer, and type it in the answer box below. So based off of just looking at this vignette, the main things we need to see here is that this is excessive daytime sleepiness. She's difficult to arouse at the end of class when she's sleeping, cannot move for extended periods, can't move her legs when some of these episodes happen, and then fall into the floor while laughing. So this is classic narcolepsy. This is exactly how most patients present here, including cataplexy as well as sleep paralysis. All of these things are classic symptoms of narcolepsy. So that means what I need to know is how do I treat narcolepsy? Alright, so let's go through the answer choices. A, chloral hydrate. This is a hypnotic. This is not something that will help treat someone that's falling asleep. This will actually help make them fall asleep for sedation and insomnia. So chloral hydrate is an opposite drug of what we want to use. B, prochlorperazine malleate. This here is an anti-psychotic. It's a typical anti-psychotic, I believe, and so we don't use this for any type of narcolepsy. Zolpidem is a hypnotic similar to the use for chloral hydrate. So we use this for insomnia so people that can't sleep, we help them sleep with zolpidem. So we don't do that for people that are falling asleep. Hydroxazine modafinil is actually a stimulant, a psychostimulant. So this is helpful in arousing the brain. So that means my final answer choice is going to be E modafinil. And E is the correct answer. So like we said here, this patient has narcolepsy. And we're also seeing cataplexy and sleep paralysis inside of this one. So this is cataplexy. If you don't know what cataplexy is, this is where they have bilateral weakness and probably doesn't have an alteration in consciousness here, but usually it's during strong emotions. So in this case, cataplexy is going to be when she talks about how she has these symptoms when she laughs at jokes or becomes nervous. So there's some of that strong emotion, laughing, crying, fear. And then also while laughing, she falls to the floor. So we're having that bilateral weakness. You're seeing that play out here during some of those high emotional states. Then sleep paralysis, that's when patients usually either right as they're falling asleep or right as they get out of the sleep cycle, they just have total paralysis. They are alert and conscious, but they just can't move. So we see that in this particular case where she says that she cannot move for extended periods after she wakes up in the morning. So treating cataplexy with modafinil, which is a psychostimulant, they can also, it's also of note those people that do have cataplexy and sleep paralysis, we can also add something to modafinil. We can also add a tricyclic antidepressant or an SSRI, selective serotonin reuptake inhibitor. If you found this material helpful for your studying, please like and consider subscribing to the channel. Also, share this video so that more people can benefit from it like you have.