Unresponsiveness Does Not Always Indicate A Conversion Episode - A Unique Case Report

This case report discusses a 22-year-old male presenting with multiple episodes of unresponsiveness, excessive daytime sleepiness, and disturbed nocturnal sleep over the past 1.5 years. Initially suspected to have a seizure disorder by neurologist, the patient's investigations were normal, leading to a referral for psychiatric evaluation in view of functional neurological symptom disorder (conversion disorder). On detailed history taking and examination in psychiatry out-patient department, patient was instead found to be suffering from narcolepsy with cataplexy (Type 1). Patient showed significant improvement in symptoms, including cessation of cataplexy and improved sleep patterns, on treatment with methylphenidate. This case highlights the importance of history taking and examination for accurate diagnosis and effective management of sleep-wake disorders like narcolepsy which often get undiagnosed in out-patient department settings.