Tactile Hallucinations in Pediatric and Young Adults With Narcolepsy: A Case Series and Review of the Literature.

BACKGROUND

To characterize the presentation and management of tactile hallucinations in pediatric and young adult patients with narcolepsy and explore the relationship between fragmented sleep, pharmacologic therapy, and psychiatric comorbidities.

METHODS

We describe four cases (ages 9, 11, 26, and 42 years) of persistent and distressing tactile hallucinations out of 55 narcolepsy patients seen at our institution. We reviewed clinical presentation, polysomnography, multiple sleep latency tests, neuroimaging, and therapeutic responses.

RESULTS

All patients exhibited excessive daytime sleepiness, and three had cataplexy. Cerebrospinal fluid orexin was low-normal in one patient. Polysomnography and multiple sleep latency tests supported the diagnosis of narcolepsy in all cases. All patients had tactile hallucinations characterized by formication and paresthesias and often exacerbated by oxybate therapy. Fragmented nocturnal sleep was common and was associated with increased hallucination severity. In one case, hallucinations contributed to suicidal ideation requiring inpatient care. Hallucinations persisted despite pharmacological adjustments, although behavioral adaptations (e.g., wearing loose clothing) and psychotherapy helped one patient. Literature review links fragmented sleep to heightened hallucinatory experiences, especially tactile forms. Oxybates, while effective for cataplexy, visual hallucinations, and daytime sleepiness, may potentiate psychotic symptoms, including tactile hallucinations.

CONCLUSIONS

Tactile hallucinations in narcolepsy may represent an under-recognized and distressing symptom. Fragmented sleep, rapid eye movement dysregulation, and pharmacologic side effects contribute to their emergence. Management requires a multidisciplinary approach integrating sleep medicine and psychiatry. Clinicians should consider hallucination profiles when titrating oxybates and explore adjunctive therapies for symptomatic relief.