Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2025 Mar;39(Suppl 1):9-22.
doi: 10.1007/s40263-024-01141-9. Epub 2025 Mar 20.

Narcolepsy: Beyond the Classic Pentad

Anne Marie Morse  1 , Seung Yun Kim  2 , Shelby Harris  3 , Monica Gow  4
Affiliations
Review

Narcolepsy: Beyond the Classic Pentad

Anne Marie Morse et al. CNS Drugs. 2025 Mar.

Abstract

Narcolepsy is a rare, disabling, chronic neurologic disorder that requires lifelong management of symptoms with pharmacologic and nonpharmacologic methods. The pentad symptoms of narcolepsy include excessive daytime sleepiness, cataplexy, disrupted nighttime sleep, sleep paralysis, and hypnagogic/hypnopompic hallucinations. However, people with narcolepsy often experience additional symptoms and disability related to nonpentad symptoms and comorbidities, such as cognitive, psychiatric, metabolic, and sleep disturbances. Current treatment strategies have focused primarily on addressing two of the pentad symptoms, excessive daytime sleepiness, and cataplexy, mainly owing to medication options being approved by the US Food and Drug Administration for these specific indications, neglecting the full 24-h impact and spectrum of symptoms. Meanwhile, the burden of disease extends far beyond these symptoms, and optimal management should reflect a comprehensive, patient-specific approach that not only addresses the entire pentad, but also goes beyond it to include the complete clinical presentation and manifestations of the disease. Individualized treatment must consider the patient's age and stage of life, most debilitating symptoms, support system and structure, comorbid conditions, treatment goals, and overall health. This review discusses care considerations for people living with narcolepsy in the context of their clinical characteristics beyond the hallmark features of narcolepsy.

PubMed Disclaimer

Conflict of interest statement

Declarations. Funding: This article has been published as part of a journal supplement wholly funded by Avadel Pharmaceuticals (Chesterfield, MO, USA). The development of this manuscript was funded by Avadel Pharmaceuticals. Open access publication and publication costs were funded by Avadel Pharmaceuticals. Conflicts of Interest: A.M.M. has served as a consultant, speaker, and/or on advisory boards for Avadel Pharmaceuticals, Eisai, Harmony Biosciences, Jazz Pharmaceuticals, Alkermes, and Takeda Pharmaceutical Co; has received grant funding from National Institutes of Health, UCB Pharmaceuticals, Jazz Pharmaceuticals, ResMed Foundation, Coverys Foundation, Harmony Biosciences, and Geisinger Health Plan; is the CEO of DAMM Good Sleep, LLC; and serves as an advisor for Neura Health and Floraworks. S.K. has no disclosures to report at this time. S.H. has served as a speaker for Jazz Pharmaceuticals. She is on the advisory board of Wake Up Narcolepsy and Project Sleep and is the founder of NY Sleep and Psychology. M.G. is cofounder and executive director of Wake Up Narcolepsy, nonprofit 501c3 organization. The organization has received grant funding for narcolepsy educational and awareness initiatives from Avadel Pharmaceuticals, Axsome Therapeutics, Harmony Biosciences, Jazz Pharmaceuticals, Takeda Pharmaceuticals, and Alkermes. Ethics Approval: Not applicable. Consent to Participate: Not applicable. Consent for Publication: Not applicable. Data Availability: Data sharing is not applicable to this article as no datasets were generated or analyzed. Code Availability: Not applicable. Author Contributions: A.M.M., S.Y.K., S.H., and M.G. were involved in the conceptualization, analysis of existing literature and data, and drafting/critically revising the manuscript. All authors have read and approved the final submitted manuscript and agree to be accountable for the work.

Figures

Fig. 1.
Fig. 1.
Symptoms and features of narcolepsy beyond the classic pentad. REM rapid eye movement
Fig. 2.
Fig. 2.
Treatment considerations for narcolepsy across the life span. ADHD attention-deficit/hyperactivity disorder
See this image and copyright information in PMC

References

    1. Scammell TE. Narcolepsy. N Engl J Med. 2015;373:2654–62. - PubMed
    1. Ahmed I, Thorpy M. Clinical features, diagnosis and treatment of narcolepsy. Clin Chest Med. 2010;31:371–81. - PubMed
    1. Bassetti CLA, Adamantidis A, Burdakov D, et al. Narcolepsy-clinical spectrum, aetiopathophysiology, diagnosis and treatment. Nat Rev Neurol. 2019;15:519–39. - PubMed
    1. Bassetti CLA, Kallweit U, Vignatelli L, et al. European guideline and expert statements on the management of narcolepsy in adults and children. Eur J Neurol. 2021;28:2815–30. - PubMed
    1. Thorpy MJ, Hiller G. The medical and economic burden of narcolepsy: Implications for managed care. Am Health Drug Benefits. 2017;10:233–41. - PMC - PubMed

LinkOut - more resources