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PubMed1998

[Hypersomnia. Narcolepsy-cataplexy (Gélineau syndrome)].

SIGNS AND SYMPTOMS: Narcolepsy is the most prevalent of the primary disorders of vigilance. It is relatively easy to identify in presence of clearcut cataplexy and other REM-sleep related symptoms, i.e. sleep paralysis and hypnagogic hallucinations. Otherwise, one must rely on demonstration of sleep onsets in REM during night and daytime polygraphy, and on the very strong association with the HLA gene DQB1*0602. TREATMENT: With the advent of modafinil, treatment of narcolepsy has been substantially modified. New strategies are an improvement over amphetamines both in terms of side effects and long-term outcome. Most cataplectic attacks can be controlled by tricyclics or other antidepressants. PATHOGENESIS: Major advances in pathophysiology and etiology have been obtained through an animal model of the disease, canine narcolepsy. Pharmacological studies point to the importance of alpha-1 adrenergic mechanisms in cataplexy, while dopaminergic systems seem more involved in generating sleepiness. As concerns genetics of this autosomal recessive disease, there is an equivalent of the human HLA association in the form of an immunoglobulin gene (mu-switch) linkage. Narcolepsy research is now looking for other genes, for which familial cases may give clues.

Animals↗
PubMed1991

Genetic markers in familial narcolepsy.

We studied three patients in a single family (father and two sons), all with long histories of overwhelming daytime sleepiness, hypnagogic hallucinations and sleep paralysis. Two of the three had a clear history of cataplexy. Multiple sleep latency tests revealed extremely short sleep onset latencies and at least two sleep onset rapid eye movement periods in each patient. Histocompatibility studies were remarkable for negative HLA-DR2 antigens in all three.

Adolescent↗
PubMed1974

Narcolepsy.

NARCOLEPSY IS A DISORDER OF SLEEP CONTROL CHARACTERIZED BY A TETRAD OF SYMPTOMS: sleep attacks, cataplexy, sleep paralysis and hypnagogic hallucinations. A diagnosis is made from a careful history. The incidence is estimated as high as 0.3% of the population. Unfortunately patients go for many years before the diagnosis is made and often have experienced disruption of their employment, social and family life, and may have experienced a number of car accidents because of falling asleep at the wheel. An unknown number of narcoleptics kill themselves on the highways before the diagnosis is ever made. Sleep attacks can usually be controlled by methylphenidate, and if the other symptoms persist they can often be effectively managed by imipramine.

Accidents, Traffic↗
PubMed1986

Narcolepsy following cerebral hypoxic ischemia.

A 51-year-old man with non-HLA-DR2 histocompatibility developed classic signs and symptoms of the narcoleptic tetrad soon after recovering from an episode of cardiopulmonary insufficiency, which occurred during induction of surgical anesthesia. Symptoms included excessive daytime sleepiness, hypnagogic hallucinations, sleep paralysis, and cataplexy. The diagnosis was confirmed by repeated polysomnographic examinations in the sleep laboratory. Cerebral hemodynamic changes during the onset of sleep showed remarkable increases of cerebral blood flow during the onset of rapid-eye-movement sleep similar to those reported previously in patients with narcolepsy. Magnetic resonance imaging showed focal regions of abnormal spin-echo signals in the ventral pons.

Anesthesia, Intravenous↗
PubMed1986

The treatment of accessory symptoms in narcolepsy: a double-blind cross-over study of a selective serotonin re-uptake inhibitor (femoxetine) versus placebo.

A randomized, double-blind cross-over trial was carried out in 10 patients with narcolepsy to evaluate the effect of 600 mg femoxetine versus placebo. In comparison to placebo, femoxetine treatment resulted in a significant decrease in both the number and severity score of cataplectic attacks per day. There were also significantly fewer attacks of sleep paralysis, whilst the effects on nightmare and hypnogenic hallucinations were minor. The frequency of sleep attacks decreased slightly during femoxetine treatment, but the overall estimated sleep time during the day and excessive daytime sleepiness remained un-affected. An ambulatory sleep recording for 48 h one week after the start of the femoxetine and placebo period showed that femoxetine treatment resulted in a significant decrease in the total time spent in REM sleep. The side-effects of femoxetine were restricted to transient nausea in 2 patients. It is concluded that femoxetine or other selective serotonin reuptake inhibitors may be a useful alternative for narcoleptic patients who experience troublesome side-effects with tricyclic antidepressants.

Adult↗
PubMed2004

Narcolepsy research: past, present, and future perspectives.

In 1877, Westphal described a patient with hypersomnia and episodic muscle weakness. He did not feel that these weakness attacks could simply be explained by "epileptoid" phenomenon. The next year, Fischer described a similar case. By 1880, Gélineau decided that patients with these symptoms represented a distinct clinical entity and he called it "narcolepsy". In 1902, Loewenfeld noted the importance of cataplexy in this disorder, and in 1934 Daniels published an important review on the topic which helped to galvanize interest in further study. In 1957, Yoss and Daly discussed the "clinical tetrad" which included hypersomnia, cataplexy, hypnagogic hallucinations, and sleep paralysis. In 1960, Vogel noted that patients with narcolepsy had early onset of REM sleep on their electroencephalograms. At the First International Symposium on Narcolepsy in 1975, the symptom of disturbed nocturnal sleep was added to the clinical diagnostic criteria for narcolepsy. For many years the etiology and mechanisms of this disease were poorly understood. It was not until the early 1970s when the exciting animal and human research first started to unravel the mysteries of the genetics and physiology of narcolepsy. This research will be discussed below.

Animals↗
PubMed1992

Motor dyscontrol in narcolepsy: rapid-eye-movement (REM) sleep without atonia and REM sleep behavior disorder.

Narcolepsy involves abnormalities of rapid-eye-movement (REM) sleep, including a short latency to the onset of REM sleep, hypnagogic hallucinations, and sleep paralysis. In addition, persistence of muscle tone by electromyographic criteria or excessive muscle twitching during REM sleep or both have been reported in treated and untreated narcoleptic patients. We report that another previously described abnormality of REM sleep, REM sleep behavior disorder, may also be a symptom of narcolepsy. This disorder was found in 10 narcoleptic patients during routine clinical evaluations involving polysomnography and multiple sleep latency tests. During REM sleep, 7 additional narcoleptic patients displayed persistent muscle tone and/or excessive twitching, which we believe to be subclinical components of REM sleep behavior disorder. These 17 patients, diagnosed by established criteria for narcolepsy and for REM sleep behavior disorder, ranged in age from 8 to 74 years. Seventy-one percent were male. Narcolepsy and REM sleep behavior disorder most commonly emerged in tandem. In 3 patients, treatment of narcolepsy-cataplexy with stimulants and tricyclics either induced or exacerbated REM sleep behavior disorder.

Adolescent↗
PubMed2001

Narcolepsy: new understanding of irresistible sleep.

Recently, low levels of a newly identified neuropeptide, hypocretin 1, were described in the cerebrospinal fluid of patients with narcolepsy. This neurochemical finding furthers our understanding of this enigmatic sleep disorder typically characterized by excessive daytime sleepiness, cataplexy, sleep paralysis, and hypnagogic hallucinations. Narcolepsy appears to be fundamentally related to abnormally regulated rapid eye movement sleep. The diagnosis of this disorder remains challenging because of multiple other conditions that can cause daytime sleepiness and the difficulties in recognizing cataplexy based on patient report. The role of hypocretins in narcolepsy is unclear but intriguing because the cell bodies are restricted to the lateral hypothalamus, a brain region long associated with sleep regulation, with neuronal widespread projections to areas including the locus ceruleus, ventral tegmental area, amygdala, and dorsal raphe. Hypocretins potentially modulate the activity of monoamines and acetylcholine, and therefore their absence leads to the multiple symptoms of narcolepsy. This article reviews the current understanding of the diagnosis and treatment of narcolepsy and discusses the possible implications of the hypocretin discovery.

Animals↗
PubMed2002

Sleep in patients with treated Wilson's disease. A questionnaire study.

OBJECTIVE: To examine general sleep habits and sleep disturbances among patients with treated Wilson's disease (WD), and in comparison with an age- and sex-matched reference group (RG). METHODS: Twenty-four patients with WD with a mean (+/-s) age of 35.1 +/- 8.7 years and a disease duration of 17.7 +/- 5.1 years were investigated using a standardized sleep questionnaire comprising 87 questions concerning sleep habits, sleeping difficulties, demographic and lifestyle variables. The results were compared with those from a random sample of 72 individuals. RESULTS: There was no significant difference in sleep time during the night, but WD patients had a significantly greater number of nocturnal awakenings compared with the RG. Fifty-nine per cent of the WD patients reported frequently being awake for more than 30 min during the night. Number of nocturnal awakenings was correlated to nightmares and palpitations only in the WD group. WD patients complained significantly more often than the RG over not feeling rested after sleep, taking frequent naps and fatigue during the daytime. Moreover, sleep paralysis and cataplexy occurred more often in the WD patients than in the RG. CONCLUSION: The sleep pattern of patients with treated WD differed from that of the reference group. The spectrum of reported symptoms by patients with treated WD suggests an altered REM sleep function. Future studies with objective methods are required to elucidate the mechanisms involved.

Adult↗
PubMed1985

[Advances in the psychopharmacological management of the narcoleptic patient].

Sleep attacks, cataplexy, sleep paralysis and hypnagogic hallucinations are the cardinal signs of narcolepsy. However most patients present only with sleep attacks at disease onset. Animal and human studies on the psychopharmacology and neurochemistry of narcolepsy, suggest abnormalities on rapid eye movement (REM) sleep. Thus, most drugs used on its treatment, such as tricyclic antidepressants and psychostimulant agents, are aimed to reduce REM sleep. However, there is growing evidence that some drugs that can alleviate fragmentation of sleep rather than suppress REM sleep can also be clinically effective for this condition. The authors review the subject and comment on their experience with clonidine, an imidazoline derivative marketed as an antihypertensive agent, and suggest that REM suppression is not always necessary for narcoleptics to improve.

Animals↗
PubMed2003

Narcolepsy.

Narcolepsy is a severely debilitating neurologic disease that is not as rare as many believe, affecting an estimated 140,000 Americans. Despite the sometimes debilitating nature of narcolepsy symptoms, the disease may go undiagnosed without an organized method for evaluating patients with sleep complaints. Many of the classic symptoms of narcolepsy, such as excessive daytime sleepiness, cataplexy, sleep paralysis, and hypnagogic hallucinations, may be mistakenly associated with other disease states and must be differentiated from other sleep disorders. The results of self-administered sleep-disorder questionnaires are useful and may increase the suspicion of narcolepsy; however, referral to an accredited sleep laboratory for a formal sleep study including overnight polysomnography is necessary for a positive narcolepsy diagnosis. A variety of medications may be used to successfully treat excessive daytime sleepiness and cataplexy, the two most debilitating symptoms of the disease. Primary-care physicians who develop the proper diagnostic skills can play a pivotal role in the accurate diagnosis and long-term management of patients suffering from narcolepsy.

Adjuvants, Anesthesia↗
PubMed1991

Narcolepsy in childhood and adolescence.

The objective of this study was to evaluate clinical, polysomnographic and the multiple sleep latency test (MSLT) features in young narcoleptics. We evaluated 14 patients with mean age of 13.6 years old (ranging from 6 to 18 years); 11 were males and 3 females. Daytime sleepiness was the main complaint in all cases and started at the ages of 6 to 17 years. Cataplexy was described in 10 cases and it was considered mild to moderate in all but one case. Sleep paralysis was present in 6 cases and hypnagogic hallucinations in 7 cases. The main polysomnographic characteristics were the short sleep latency in 9 cases and the sudden onset of REM periods in 7 cases. The MSLT showed short or borderline sleep latencies in 13 cases, with a mean of 4.9 min; 2 or more REM periods were present in 13 cases. Clinical, polysomnographic and MSLT characteristics in the age bracket focused were remarkably similar to those of adult narcoleptics suggesting the stability of these physiopathological markers.

Adolescent↗
PubMed1998

Genetic studies in the sleep disorder narcolepsy.

Narcolepsy is a chronic neurologic disorder characterized by excessive daytime sleepiness and abnormal manifestations of REM sleep including cataplexy, sleep paralysis, and hypnagogic hallucinations. Narcolepsy is both a significant medical problem and a unique disease model for the study of sleep. Research in human narcolepsy has led to the identification of specific HLA alleles (DQB1*0602 and DQA1*0102) that predispose to the disorder. This has suggested the possibility that narcolepsy may be an autoimmune disorder, a hypothesis that has not been confirmed to date. Genetic factors other than HLA are also likely to be involved. In a canine model of narcolepsy, the disorder is transmitted as a non-MHC single autosomal recessive trait with full penetrance (canarc-1). A tightly linked marker for canarc-1 has been identified, and positional cloning studies are under way to isolate canarc-1 from a newly developed canine genomic BAC library. The molecular cloning of this gene may lead to a better understanding of sleep mechanisms, as has been the case for circadian rhythms following the cloning of frq, per, and Clock.

Alleles↗
PubMed1975

Depresssion in narcolepsy and hypersommia.

The authors studied the occurrence of depression in 100 randomly selected patients with narcolepsy and in 30 patients with hypersomnia. In the isolated form of idiopathic narcolepsy (without signs of cataplexy, sleep paralysis or hypnagogic hallucinations) depression occurred 28.6 per cent of cases. In idiopathic narcolepsy with cataplexy or other symptoms of sleep dissociation, depression was found in 17.2 per cent of cases. In idiopathic hypersomnia the occurrence of depression was 26.1 per cent. In the majority of cases the endogenous form of depression was observed. In the symptomatic form of narcolepsy and hypersomnia the occurence of depression has not been noted in any case. In most cases a parallel clincial course has been observed between the manifestation of depression and narcolepsy or hypersomnia. During a remission of the depressive state the hypersomniac symptoms decreased or disappeared totally. The authors furter discuss the possible pathophysiological mechanisms of the above mentioned symptoms. They are of the opinion that an important role is played by the secretion and metabolism of the cerebral monamines.

Cataplexy↗
PubMed2005

Odds, prevalence and predictors of sleep problems in school-age normal children.

The objectives of the study were to describe the prevalence, odds, and predictors of 36 paediatric sleep behaviours and describe their coexistence in a school-age normal population. The design was community-based questionnaire survey of sleep-wake patterns, sleep environment, and 36 sleep behaviours indicative of six sleep disorder-subscales using the Health-Behaviour Questionnaire. A caregivers' report of 3045 children aged 6-13 years in Belgium constituted the participants. Prevalence of each sleep behaviour was calculated. Log-linear modelling within and between the sleep disorder-subscales was used to screen for coexistence. The effect size of selected night-time parameters to the likelihood of sleep behaviours and disorder-subscale was expressed as odds ratios via logit regression analysis. Significant differences in sleep-wake patterns were found between weekday and weekend. Ranking by odds showed that: (1) sleep problems such as 'tired when waking up', 'repetitive limb movements', 'going to bed reluctantly', and 'sleep paralysis' and; (2) the disorder-subscale 'excessive somnolence' are common in children. Coexistences within and between disorder-subscales of sleep problems are evident in a school-age, normal population. These results suggest that disorders of excessive somnolence (DES) are highly prevalent in a non-clinical sample of school-age children. Furthermore, sleep-onset latency and a noisy, not well-darkened room are predictive towards the odds for exhibiting sleep problems and disorders. It is advocated that more information on the importance of good sleep-wake hygiene should reach parents and children.

Adolescent↗
PubMed1998

Diagnostic aspects of narcolepsy.

The diagnostic criteria for narcolepsy continue to evolve as more is learned about the features of this and other sleep disorders. A variety of symptoms have been said to distinguish narcolepsy from other sleep disorders, including cataplexy, character of daytime sleepiness, sleep paralysis, hypnagogic hallucinations, and automatic behavior. Other diagnostic assessments, such as determination of human leukocyte antigen (HLA) haplotype and findings of sleep laboratory assessments, also contribute to the differential diagnosis. As diagnostic and analytic techniques have become more sophisticated, however, it has become apparent that many of the characteristic features of narcolepsy--including the HLA-DR2 haplotype, sleep-onset REM sleep, and short sleep latency--may also be present in other sleep disorders. Although unambiguous cataplexy does not occur with other sleep disorders and is therefore a valuable symptom for diagnosis, it may occur with a few other neurologic disorders. Furthermore, the clinical assessment of cataplexy-like symptoms is not always straightforward. Current evidence suggests there is a fairly well-defined syndrome of narcolepsy-cataplexy that is highly associated with specific HLA markers and REM sleep abnormalities. On the other hand, there is substantial clinical overlap between narcolepsy without cataplexy and idiopathic hypersomnia. Patients with features of narcolepsy who do not have definite cataplexy and patients with features of idiopathic hypersomnia must be assessed thoroughly because of the possibility that other sleep disorders are the cause of the symptoms.

Biomarkers↗
PubMed2002

Elicitation of sleep-onset REM periods in normal individuals using the sleep interruption technique (SIT).

Use of the sleep interruption technique (SIT) to elicit sleep onset REM periods (SOREMPs) in normal individuals is introduced along with its theoretical bases, empirical findings, and potential applications. Capitalizing upon the circadian and ultradian nature of REM sleep, the SIT has been developed to examine various psychophysiological characteristics related to REM sleep. The SIT allows us to: (1) obtain SOREMPs at the discretion of the researcher; (2) avoid the contaminating effects of preceding non-REM (NREM)-REM stage ordering on subsequent target sleep episodes; and (3) obtain many REM episodes in a short time by repeating the sleep interruptions. The SIT has been applied in several studies, such as examination of physiological precursors to REM periods, correlates of dream mechanisms, and induction of sleep paralysis in normal individuals. Guidelines for eliciting SOREMP using the SIT, including the parameters to be manipulated, are provided, e.g. NREM duration before sleep interruption, time of night of awakenings, duration of sleep interruption and tasks employed. Directions for further research such as determining optimal type of task to promote SOREMP occurrences, generalization of SOREMP as usual REM periods, and forms of SOREMP occurrences under different conditions in normal individuals and clinical patients are discussed. Finally, possible future uses of the SIT, including combining this technique with new technologies, are also suggested.

Journal Article↗
PubMed2001

Childhood narcolepsy in North China.

STUDY OBJECTIVES: The purpose is to report the results of an effort to diagnose children with narcolepsy in a pediatric referral clinic. DESIGN: Between September 1998 and December 1999, a program was implemented to emphasize recognition of childhood narcolepsy. Patients underwent brain computed tomography (CT) scan and magnetic resonance imaging (MRI) testing. All children received a MSLT test following a routine night's sleep, and serological HLA typing for HLA DR2. Three who reported occasional snoring also underwent nocturnal PSG prior to the MSLT. SETTING: N/A. PATIENTS OR PARTICIPANTS: N/A. INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: 29 (21 male, 8 female) children were identified with sleepiness and cataplexy. There was no evidence for brain functional or structural disease or for drug use. Sleep paralysis was elicited in 41%; hypnagogic hallucinations, in 59%. Psychosocial problems including emotional irritability and social isolation were present in 93% of the patients. Mean sleep latency on MSLT was 2.0+/-1.3 minutes; sleep-onset rapid eye movement (SOREM) occurred during 2/5 naps in 28 of 29 patients and 3/5 in 26/29 patients. The average number and latency of SOREM episodes were 4.2+/-0.9 episodes and 4.0+/-1.7 minutes, respectively. In those with snoring, a nocturnal PSG did not disclose sleep apneas/hypopneas. All patients but one were HLA DR2 positive. The estimated clinic incidence was 0.04%. CONCLUSIONS: A program for recognition in a referral neurology clinic combined with an availability of the MSLT and HLA testing resulted in the new identification in North China of a number of children with narcolepsy syndromes.

Adolescent↗