1151 Tactile Hallucinations in Pediatric and Young Adults with Narcolepsy: A Case Series and Review of the Literature

Abstract Introduction 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) of persistent and distressing tactile hallucinations out of 55 narcolepsy patients seen at our institution. We reviewed clinical presentation, polysomnography (PSG), Multiple Sleep Latency Tests (MSLT), neuroimaging, and therapeutic responses. Results All patients exhibited excessive daytime sleepiness, and three had cataplexy. CSF orexin was low-normal in one patient. PSG and MSLT supported the diagnosis of narcolepsy in all cases. Besides visual hallucinations, all patients also had tactile hallucinations characterized by formication and paresthesia's and often exacerbated by sodium 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. Sodium Oxybates, while effective for cataplexy, visual hallucinations, and daytime sleepiness, may potentiate psychotic symptoms, including tactile hallucinations. Conclusion Tactile hallucinations in narcolepsy may represent an underrecognized and distressing symptom. Fragmented sleep, REM 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 sodium oxybates and explore adjunctive therapies for symptomatic relief. Support (if any)