Piknolepsy

Piknolepsy, a disease characterized by extremely frequent (up to 100 or more per day) attacks of brief disturbances of consciousness. The duration of an attack is usually several seconds. They differ from epileptic 'absences' in being superficial and incomplete in the loss of consciousness, approaching most closely to states of drowsiness. The disease occurs exclusively in children, does not lead to dementia, passes spontaneously and without trace—most often by the time of puberty, and does not respond to therapy (including bromide therapy). The disease was described in 1906 by Friedman (M. Friedmann), who personally considered the cases he observed to be true narcolepsy (see) (Gelineau). Subsequent authors, in view of the absence in these cases of the cardinal symptom of narcolepsy—attacks of affective loss of tone—came to consider them as a special disease distinct from narcolepsy. The main differences between P. and Gélineau's narcolepsy, besides those mentioned, are the following (Redlich): narcolepsy occurs more often directly after the age of puberty and in adults, while P. occurs exclusively in children; attacks of drowsiness in narcolepsy repeat from 3 to 5 times a day, rarely more, while in P.—up to 100 times a day; the duration of the former is many minutes, sometimes hours, while the latter is several seconds; the attack itself in narcolepsy is much closer to natural physiological sleep than piknoleptic attacks; finally, P. passes with the years, while narcolepsy shows no tendency to change. In a number of cases, P. is difficult to differentiate from epilepsy; hereditary data also seem to indicate a greater closeness to epilepsy compared to narcolepsy. Along with this prevailing opinion in the literature about the profound difference between the two diseases, there also exists the view of Gruhle, who continues to consider P. a variety of narcolepsy (type II). The Russian author Ratner combines P. and narcolepsy together with a whole series of other diseases into the group of 'diencephaloses' (morbid states caused by inadequacy of the intermediate brain).