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Ten-Blanco M, Flores Á, Cristino L, Pereda-Pérez I, Berrendero F. Targeting the orexin/hypocretin system for the treatment of neuropsychiatric and neurodegenerative diseases: from animal to clinical studies. Front Neuroendocrinol 2023; 69:101066. [PMID: 37015302 DOI: 10.1016/j.yfrne.2023.101066] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 03/15/2023] [Accepted: 03/30/2023] [Indexed: 04/06/2023]
Abstract
Orexins (also known as hypocretins) are neuropeptides located exclusively in hypothalamic neurons that have extensive projections throughout the central nervous system and bind two different G protein-coupled receptors (OX1R and OX2R). Since its discovery in 1998, the orexin system has gained the interest of the scientific community as a potential therapeutic target for the treatment of different pathological conditions. Considering previous basic science research, a dual orexin receptor antagonist, suvorexant, was the first orexin agent to be approved by the US Food and Drug Administration to treat insomnia. In this review, we discuss and update the main preclinical and human studies involving the orexin system with several psychiatric and neurodegenerative diseases. This system constitutes a nice example of how basic scientific research driven by curiosity can be the best route to the generation of new and powerful pharmacological treatments.
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Affiliation(s)
- Marc Ten-Blanco
- Faculty of Experimental Sciences, Universidad Francisco de Vitoria, 28223 Pozuelo de Alarcón, Madrid, Spain
| | - África Flores
- Pharmacology Unit, Department of Pathology and Experimental Therapeutics, Neurosciences Institute, University of Barcelona and Bellvitge University Hospital-IDIBELL, 08908 L'Hospitalet de Llobregat, Barcelona, Spain
| | - Luigia Cristino
- Endocannabinoid Research Group, Institute of Biomolecular Chemistry (ICB), National Research Council (CNR), Pozzuoli, Italy
| | - Inmaculada Pereda-Pérez
- Faculty of Experimental Sciences, Universidad Francisco de Vitoria, 28223 Pozuelo de Alarcón, Madrid, Spain
| | - Fernando Berrendero
- Faculty of Experimental Sciences, Universidad Francisco de Vitoria, 28223 Pozuelo de Alarcón, Madrid, Spain.
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Johansson K, Wasling P, Axelsson M. Fatigue, insomnia and daytime sleepiness in multiple sclerosis versus narcolepsy. Acta Neurol Scand 2021; 144:566-575. [PMID: 34278566 DOI: 10.1111/ane.13497] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 06/20/2021] [Accepted: 06/24/2021] [Indexed: 01/13/2023]
Abstract
OBJECTIVES In multiple sclerosis (MS), fatigue is the most prevalent cause of impaired ability to work. In narcolepsy, daytime sleepiness is the main symptom but some studies indicate fatigue being present. We aimed to assess fatigue and associated features in patients with MS or narcolepsy and healthy controls and to assess whether clinical parameters separate fatigued (MS-F) and non-fatigued MS patients (MS-NoF). MATERIALS & METHODS In this non-interventional cross-sectional study, we recruited 34 MS patients, 15 narcolepsy type 1 patients and 17 healthy controls. An interviewer administered the Fatigue Severity Scale (FSS), the Insomnia Severity Index (ISI), the Epworth Sleepiness Scale, the Patient Health Questionnaire-9 and the Saltin-Grimby Physical Activity Level Scale. Information about clinical parameters and current treatments was collected. RESULTS In its fatigue profile, MS-F resembled the narcolepsy group rather than MS-NoF, which resembled the healthy control group. ISI alone was significantly associated with FSS, and only in MS-NoF and healthy controls; in MS-F and the narcolepsy group, no variable was associated with FSS. Months since diagnosis was the only clinical variable significantly separating MS-F from MS-NoF. In MS, disease duration correlated with fatigue. No clinical variables correlated with fatigue in the narcolepsy group. CONCLUSIONS Fatigued MS patients resemble narcolepsy patients more than they resemble non-fatigued MS patients, who resemble healthy controls. Insomnia is the main factor associated with fatigue in MS, while disease duration is the only clinical variable separating fatigued and non-fatigued MS patients. In fatigued patients, variance in fatigue cannot be explained by insomnia, daytime sleepiness, depression or level of exercise.
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Affiliation(s)
- Kalle Johansson
- Department of Clinical Neuroscience Institute of Neuroscience and Physiology Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
| | - Pontus Wasling
- Department of Clinical Neuroscience Institute of Neuroscience and Physiology Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
- Department of Neurology Sahlgrenska Universtity Hospital Gothenburg Sweden
| | - Markus Axelsson
- Department of Clinical Neuroscience Institute of Neuroscience and Physiology Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
- Department of Neurology Sahlgrenska Universtity Hospital Gothenburg Sweden
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Dubessy AL, Tezenas du Montcel S, Viala F, Assouad R, Tiberge M, Papeix C, Lubetzki C, Clanet M, Arnulf I, Stankoff B. Association of Central Hypersomnia and Fatigue in Patients With Multiple Sclerosis: A Polysomnographic Study. Neurology 2021; 97:e23-e33. [PMID: 33931534 DOI: 10.1212/wnl.0000000000012120] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 03/22/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To evaluate sleepiness and central hypersomnia in multiple sclerosis (MS)-associated fatigue, we performed long-term polysomnography in patients with MS and healthy controls. METHODS Patients with MS and healthy controls completed questionnaires on sleep, fatigue, sleepiness, and depression. They underwent nocturnal polysomnography, multiple sleep latency tests, and bed rest 24-hour polysomnography. Patients were divided into 3 groups (fatigue and sleepiness, fatigue and no sleepiness, neither fatigue nor sleepiness). RESULTS Among 44 patients with MS, 19 (43.2%) had fatigue and sleepiness, 15 (34%) had only fatigue, and 10 (22.7%) had neither fatigue nor sleepiness. Compared to 24 controls, patients with fatigue and sleepiness had higher REM sleep percentages (median [interquartile range] 20.5% [19.6-24.7] vs 18.1% [12.6-20.6]), lower arousal indexes (12.7 [7.5-17.0] vs 22.4 [14.3-34.4]), and shorter daytime mean sleep latencies (8.6 [6.3-14.3] vs 16.6 [12.6-19.5] min). Restless leg syndrome, periodic leg movements, and sleep apnea had similar frequencies between groups. Central hypersomnia was found in 10 (53%) patients with fatigue and sleepiness (narcolepsy type 2, n = 2), in 2 (13%) patients with fatigue only, and in 3 (30%) patients with neither fatigue nor sleepiness. Patients with central hypersomnia were younger and sleepier than those without hypersomnia, but had similar levels of fatigue, disability, depression, cognitive performance, and frequencies of the human leukocyte antigen DQB1*0602 genotype. The severity of fatigue increased with higher depression scores, higher sleepiness severity, and lower sleep efficacy. CONCLUSION Central hypersomnias are frequent in MS when fatigue and sleepiness are present. Screening them through polysomnography studies is recommended.
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Affiliation(s)
- Anne-Laure Dubessy
- From the Neurology Department (A.-L.D., B.S.), Saint Antoine Hospital, AP-HP; Sleep Disorders Unit and National Reference Center for Narcolepsy and Hypersomnia (A.-L.D., I.A.), Department of Biostatistics (S.T.d.M.), and Neurology Department (R.A., C.P., C.L.), Pitié-Salpêtrière University Hospital, APHP, Paris; Neurology Department (F.V., M.C.) and Neurophysiology Department (M.T.), Purpan Hospital, Toulouse; and Institut du Cerveau et de la Moelle Épinière (C.L., I.A., B.S.), Sorbonne Université, Hôpital de la Pitié Salpêtrière, Inserm UMR S 1127, CNRS UMR 7225, Paris, France
| | - Sophie Tezenas du Montcel
- From the Neurology Department (A.-L.D., B.S.), Saint Antoine Hospital, AP-HP; Sleep Disorders Unit and National Reference Center for Narcolepsy and Hypersomnia (A.-L.D., I.A.), Department of Biostatistics (S.T.d.M.), and Neurology Department (R.A., C.P., C.L.), Pitié-Salpêtrière University Hospital, APHP, Paris; Neurology Department (F.V., M.C.) and Neurophysiology Department (M.T.), Purpan Hospital, Toulouse; and Institut du Cerveau et de la Moelle Épinière (C.L., I.A., B.S.), Sorbonne Université, Hôpital de la Pitié Salpêtrière, Inserm UMR S 1127, CNRS UMR 7225, Paris, France
| | - Frederique Viala
- From the Neurology Department (A.-L.D., B.S.), Saint Antoine Hospital, AP-HP; Sleep Disorders Unit and National Reference Center for Narcolepsy and Hypersomnia (A.-L.D., I.A.), Department of Biostatistics (S.T.d.M.), and Neurology Department (R.A., C.P., C.L.), Pitié-Salpêtrière University Hospital, APHP, Paris; Neurology Department (F.V., M.C.) and Neurophysiology Department (M.T.), Purpan Hospital, Toulouse; and Institut du Cerveau et de la Moelle Épinière (C.L., I.A., B.S.), Sorbonne Université, Hôpital de la Pitié Salpêtrière, Inserm UMR S 1127, CNRS UMR 7225, Paris, France
| | - Rana Assouad
- From the Neurology Department (A.-L.D., B.S.), Saint Antoine Hospital, AP-HP; Sleep Disorders Unit and National Reference Center for Narcolepsy and Hypersomnia (A.-L.D., I.A.), Department of Biostatistics (S.T.d.M.), and Neurology Department (R.A., C.P., C.L.), Pitié-Salpêtrière University Hospital, APHP, Paris; Neurology Department (F.V., M.C.) and Neurophysiology Department (M.T.), Purpan Hospital, Toulouse; and Institut du Cerveau et de la Moelle Épinière (C.L., I.A., B.S.), Sorbonne Université, Hôpital de la Pitié Salpêtrière, Inserm UMR S 1127, CNRS UMR 7225, Paris, France
| | - Michel Tiberge
- From the Neurology Department (A.-L.D., B.S.), Saint Antoine Hospital, AP-HP; Sleep Disorders Unit and National Reference Center for Narcolepsy and Hypersomnia (A.-L.D., I.A.), Department of Biostatistics (S.T.d.M.), and Neurology Department (R.A., C.P., C.L.), Pitié-Salpêtrière University Hospital, APHP, Paris; Neurology Department (F.V., M.C.) and Neurophysiology Department (M.T.), Purpan Hospital, Toulouse; and Institut du Cerveau et de la Moelle Épinière (C.L., I.A., B.S.), Sorbonne Université, Hôpital de la Pitié Salpêtrière, Inserm UMR S 1127, CNRS UMR 7225, Paris, France
| | - Caroline Papeix
- From the Neurology Department (A.-L.D., B.S.), Saint Antoine Hospital, AP-HP; Sleep Disorders Unit and National Reference Center for Narcolepsy and Hypersomnia (A.-L.D., I.A.), Department of Biostatistics (S.T.d.M.), and Neurology Department (R.A., C.P., C.L.), Pitié-Salpêtrière University Hospital, APHP, Paris; Neurology Department (F.V., M.C.) and Neurophysiology Department (M.T.), Purpan Hospital, Toulouse; and Institut du Cerveau et de la Moelle Épinière (C.L., I.A., B.S.), Sorbonne Université, Hôpital de la Pitié Salpêtrière, Inserm UMR S 1127, CNRS UMR 7225, Paris, France
| | - Catherine Lubetzki
- From the Neurology Department (A.-L.D., B.S.), Saint Antoine Hospital, AP-HP; Sleep Disorders Unit and National Reference Center for Narcolepsy and Hypersomnia (A.-L.D., I.A.), Department of Biostatistics (S.T.d.M.), and Neurology Department (R.A., C.P., C.L.), Pitié-Salpêtrière University Hospital, APHP, Paris; Neurology Department (F.V., M.C.) and Neurophysiology Department (M.T.), Purpan Hospital, Toulouse; and Institut du Cerveau et de la Moelle Épinière (C.L., I.A., B.S.), Sorbonne Université, Hôpital de la Pitié Salpêtrière, Inserm UMR S 1127, CNRS UMR 7225, Paris, France
| | - Michel Clanet
- From the Neurology Department (A.-L.D., B.S.), Saint Antoine Hospital, AP-HP; Sleep Disorders Unit and National Reference Center for Narcolepsy and Hypersomnia (A.-L.D., I.A.), Department of Biostatistics (S.T.d.M.), and Neurology Department (R.A., C.P., C.L.), Pitié-Salpêtrière University Hospital, APHP, Paris; Neurology Department (F.V., M.C.) and Neurophysiology Department (M.T.), Purpan Hospital, Toulouse; and Institut du Cerveau et de la Moelle Épinière (C.L., I.A., B.S.), Sorbonne Université, Hôpital de la Pitié Salpêtrière, Inserm UMR S 1127, CNRS UMR 7225, Paris, France
| | - Isabelle Arnulf
- From the Neurology Department (A.-L.D., B.S.), Saint Antoine Hospital, AP-HP; Sleep Disorders Unit and National Reference Center for Narcolepsy and Hypersomnia (A.-L.D., I.A.), Department of Biostatistics (S.T.d.M.), and Neurology Department (R.A., C.P., C.L.), Pitié-Salpêtrière University Hospital, APHP, Paris; Neurology Department (F.V., M.C.) and Neurophysiology Department (M.T.), Purpan Hospital, Toulouse; and Institut du Cerveau et de la Moelle Épinière (C.L., I.A., B.S.), Sorbonne Université, Hôpital de la Pitié Salpêtrière, Inserm UMR S 1127, CNRS UMR 7225, Paris, France
| | - Bruno Stankoff
- From the Neurology Department (A.-L.D., B.S.), Saint Antoine Hospital, AP-HP; Sleep Disorders Unit and National Reference Center for Narcolepsy and Hypersomnia (A.-L.D., I.A.), Department of Biostatistics (S.T.d.M.), and Neurology Department (R.A., C.P., C.L.), Pitié-Salpêtrière University Hospital, APHP, Paris; Neurology Department (F.V., M.C.) and Neurophysiology Department (M.T.), Purpan Hospital, Toulouse; and Institut du Cerveau et de la Moelle Épinière (C.L., I.A., B.S.), Sorbonne Université, Hôpital de la Pitié Salpêtrière, Inserm UMR S 1127, CNRS UMR 7225, Paris, France
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Popp RF, Fierlbeck AK, Knüttel H, König N, Rupprecht R, Weissert R, Wetter TC. Daytime sleepiness versus fatigue in patients with multiple sclerosis: A systematic review on the Epworth sleepiness scale as an assessment tool. Sleep Med Rev 2017; 32:95-108. [DOI: 10.1016/j.smrv.2016.03.004] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 02/26/2016] [Accepted: 03/09/2016] [Indexed: 11/24/2022]
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Jennum PJ, Kornum BR, Issa NM, Gammeltoft S, Tommerup N, Morling N, Tümer Z, Knudsen S. Monozygotic twins discordant for narcolepsy type 1 and multiple sclerosis. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2016; 3:e249. [PMID: 27354986 PMCID: PMC4911794 DOI: 10.1212/nxi.0000000000000249] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Accepted: 05/06/2016] [Indexed: 11/15/2022]
Affiliation(s)
- Poul J Jennum
- Danish Center for Sleep Medicine (P.J.J., S.K.) and Molecular Sleep Laboratory, Department of Clinical Biochemistry (B.R.K., S.G.), University of Copenhagen, Rigshospitalet, Glostrup, Denmark; Norwegian Centre of Expertise for Neurodevelopmental Disorders and Hypersomnias (NevSom) (S.K.), Oslo University Hospital, Ullevål, Norway; Department of Neurology (N.M.I.), University of Copenhagen, Hillerød Hospital; Department of Cellular and Molecular Medicine, Panum Institute (N.T.), and Section of Forensic Genetics, Department of Forensic Medicine, Faculty of Health and Medical Science (N.M.), University of Copenhagen; Applied Human Molecular Genetics (Z.T.), Kennedy Center, Department of Clinical Genetics, Copenhagen University Hospital, Rigshospitalet, Glostrup, Denmark
| | - Birgitte R Kornum
- Danish Center for Sleep Medicine (P.J.J., S.K.) and Molecular Sleep Laboratory, Department of Clinical Biochemistry (B.R.K., S.G.), University of Copenhagen, Rigshospitalet, Glostrup, Denmark; Norwegian Centre of Expertise for Neurodevelopmental Disorders and Hypersomnias (NevSom) (S.K.), Oslo University Hospital, Ullevål, Norway; Department of Neurology (N.M.I.), University of Copenhagen, Hillerød Hospital; Department of Cellular and Molecular Medicine, Panum Institute (N.T.), and Section of Forensic Genetics, Department of Forensic Medicine, Faculty of Health and Medical Science (N.M.), University of Copenhagen; Applied Human Molecular Genetics (Z.T.), Kennedy Center, Department of Clinical Genetics, Copenhagen University Hospital, Rigshospitalet, Glostrup, Denmark
| | - Nadia M Issa
- Danish Center for Sleep Medicine (P.J.J., S.K.) and Molecular Sleep Laboratory, Department of Clinical Biochemistry (B.R.K., S.G.), University of Copenhagen, Rigshospitalet, Glostrup, Denmark; Norwegian Centre of Expertise for Neurodevelopmental Disorders and Hypersomnias (NevSom) (S.K.), Oslo University Hospital, Ullevål, Norway; Department of Neurology (N.M.I.), University of Copenhagen, Hillerød Hospital; Department of Cellular and Molecular Medicine, Panum Institute (N.T.), and Section of Forensic Genetics, Department of Forensic Medicine, Faculty of Health and Medical Science (N.M.), University of Copenhagen; Applied Human Molecular Genetics (Z.T.), Kennedy Center, Department of Clinical Genetics, Copenhagen University Hospital, Rigshospitalet, Glostrup, Denmark
| | - Steen Gammeltoft
- Danish Center for Sleep Medicine (P.J.J., S.K.) and Molecular Sleep Laboratory, Department of Clinical Biochemistry (B.R.K., S.G.), University of Copenhagen, Rigshospitalet, Glostrup, Denmark; Norwegian Centre of Expertise for Neurodevelopmental Disorders and Hypersomnias (NevSom) (S.K.), Oslo University Hospital, Ullevål, Norway; Department of Neurology (N.M.I.), University of Copenhagen, Hillerød Hospital; Department of Cellular and Molecular Medicine, Panum Institute (N.T.), and Section of Forensic Genetics, Department of Forensic Medicine, Faculty of Health and Medical Science (N.M.), University of Copenhagen; Applied Human Molecular Genetics (Z.T.), Kennedy Center, Department of Clinical Genetics, Copenhagen University Hospital, Rigshospitalet, Glostrup, Denmark
| | - Niels Tommerup
- Danish Center for Sleep Medicine (P.J.J., S.K.) and Molecular Sleep Laboratory, Department of Clinical Biochemistry (B.R.K., S.G.), University of Copenhagen, Rigshospitalet, Glostrup, Denmark; Norwegian Centre of Expertise for Neurodevelopmental Disorders and Hypersomnias (NevSom) (S.K.), Oslo University Hospital, Ullevål, Norway; Department of Neurology (N.M.I.), University of Copenhagen, Hillerød Hospital; Department of Cellular and Molecular Medicine, Panum Institute (N.T.), and Section of Forensic Genetics, Department of Forensic Medicine, Faculty of Health and Medical Science (N.M.), University of Copenhagen; Applied Human Molecular Genetics (Z.T.), Kennedy Center, Department of Clinical Genetics, Copenhagen University Hospital, Rigshospitalet, Glostrup, Denmark
| | - Niels Morling
- Danish Center for Sleep Medicine (P.J.J., S.K.) and Molecular Sleep Laboratory, Department of Clinical Biochemistry (B.R.K., S.G.), University of Copenhagen, Rigshospitalet, Glostrup, Denmark; Norwegian Centre of Expertise for Neurodevelopmental Disorders and Hypersomnias (NevSom) (S.K.), Oslo University Hospital, Ullevål, Norway; Department of Neurology (N.M.I.), University of Copenhagen, Hillerød Hospital; Department of Cellular and Molecular Medicine, Panum Institute (N.T.), and Section of Forensic Genetics, Department of Forensic Medicine, Faculty of Health and Medical Science (N.M.), University of Copenhagen; Applied Human Molecular Genetics (Z.T.), Kennedy Center, Department of Clinical Genetics, Copenhagen University Hospital, Rigshospitalet, Glostrup, Denmark
| | - Zeynep Tümer
- Danish Center for Sleep Medicine (P.J.J., S.K.) and Molecular Sleep Laboratory, Department of Clinical Biochemistry (B.R.K., S.G.), University of Copenhagen, Rigshospitalet, Glostrup, Denmark; Norwegian Centre of Expertise for Neurodevelopmental Disorders and Hypersomnias (NevSom) (S.K.), Oslo University Hospital, Ullevål, Norway; Department of Neurology (N.M.I.), University of Copenhagen, Hillerød Hospital; Department of Cellular and Molecular Medicine, Panum Institute (N.T.), and Section of Forensic Genetics, Department of Forensic Medicine, Faculty of Health and Medical Science (N.M.), University of Copenhagen; Applied Human Molecular Genetics (Z.T.), Kennedy Center, Department of Clinical Genetics, Copenhagen University Hospital, Rigshospitalet, Glostrup, Denmark
| | - Stine Knudsen
- Danish Center for Sleep Medicine (P.J.J., S.K.) and Molecular Sleep Laboratory, Department of Clinical Biochemistry (B.R.K., S.G.), University of Copenhagen, Rigshospitalet, Glostrup, Denmark; Norwegian Centre of Expertise for Neurodevelopmental Disorders and Hypersomnias (NevSom) (S.K.), Oslo University Hospital, Ullevål, Norway; Department of Neurology (N.M.I.), University of Copenhagen, Hillerød Hospital; Department of Cellular and Molecular Medicine, Panum Institute (N.T.), and Section of Forensic Genetics, Department of Forensic Medicine, Faculty of Health and Medical Science (N.M.), University of Copenhagen; Applied Human Molecular Genetics (Z.T.), Kennedy Center, Department of Clinical Genetics, Copenhagen University Hospital, Rigshospitalet, Glostrup, Denmark
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Abstract
Central hypersomnias are diseases manifested in excessive daytime sleepiness (EDS) not caused by disturbed nocturnal sleep or misaligned circadian rhythms. Central hypersomnias includes narcolepsy with and without cataplexy, recurrent hypersomnia, idiopathic hypersomnia, with and without long sleep time, behaviorally induced insufficient sleep syndrome, hypersomnia and narcolepsy due to medical conditions, and finally hypersomnia induced by substance intake. The Epworth Sleepiness Scale is a subjective tool mostly used for EDS assessment, while the Multiple Sleep Latency Test serves as an objective diagnostic method for narcolepsy and idiopathic hypersomnias. As for symptomatic therapy of EDS, the central nervous system stimulants modafinil and methylphenidate seem to work well in most cases and in narcolepsy and Parkinson's disease; sodium oxybate also has notable therapeutic value.
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Affiliation(s)
- Karel Sonka
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Katerinska 30, Prague, Czech Republic
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Fatigue in multiple sclerosis - a brief review. J Neurol Sci 2012; 323:9-15. [PMID: 22935407 DOI: 10.1016/j.jns.2012.08.007] [Citation(s) in RCA: 146] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Revised: 06/26/2012] [Accepted: 08/08/2012] [Indexed: 11/22/2022]
Abstract
Fatigue is the most common and debilitating symptom in multiple sclerosis (MS) and is believed to be distinctly different from fatigue seen in other chronic conditions. It can affect a patient's mood, sleep and have a detrimental effect on their quality of life. In the recent years much literature has emerged in an attempt to elucidate the potential causes and treatment of this common symptom. This review article aims to examine the most recent theories on the pathophysiology of fatigue in MS as well as its association with sleep and depression. We describe the pharmacological and non-pharmacological approaches to its treatment and propose a multidisciplinary, patient enabled and individualised manner to the management of fatigue in MS.
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Constantinescu CS, Niepel G, Patterson M, Judd A, Braitch M, Fahey AJ, Harikrishnan S, Edwards LJ, Tench CR, Bennett GW, Ghatei M. Orexin A (hypocretin-1) levels are not reduced while cocaine/amphetamine regulated transcript levels are increased in the cerebrospinal fluid of patients with multiple sclerosis: no correlation with fatigue and sleepiness. J Neurol Sci 2011; 307:127-31. [PMID: 21605873 DOI: 10.1016/j.jns.2011.04.024] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2010] [Revised: 04/21/2011] [Accepted: 04/25/2011] [Indexed: 11/25/2022]
Abstract
BACKGROUND Fatigue and sleep disturbance are common features of multiple sclerosis (MS). Our objectives were to determine cerebrospinal fluid levels of orexin A (hypocretin-1), a hypothalamic peptide involved in sleep, in patients with MS, and correlate them with fatigue, sleepiness, and levels of cocaine and amphetamine regulated transcript (CART) another neuropeptide regulating metabolism with wider nervous system distribution. METHODS Consecutive patients with MS (n=34), other inflammatory (n=24) or non-inflammatory (n=42) neurological diseases, undergoing lumbar puncture were investigated. Orexin and CART were measured by RIA by investigators unaware of the patients' diagnosis. RESULTS Orexin A was slightly decreased in the cerebrospinal fluid of patients with inflammatory disease. There was no evidence of orexin A deficiency in MS, although there was a non-significant trend toward a decrease compared to non-inflammatory neurological diseases (p=0.06). CART levels were increased in MS compared to the non-inflammatory disease group (p=0.03). There were no significant correlations between CSF levels of orexin A and CART, fatigue, and hypersomnolence. CONCLUSIONS Cerebrospinal fluid orexin A is decreased in CNS inflammatory diseases other than MS, where it shows a trend toward reduction, but does not correlate significantly with CART or with measures of fatigue and hypersomnolence.
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Affiliation(s)
- Cris S Constantinescu
- Division of Clinical Neurology, School of Clinical Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, UK.
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Knudsen S, Jennum PJ, Alving J, Sheikh SP, Gammeltoft S. Validation of the ICSD-2 criteria for CSF hypocretin-1 measurements in the diagnosis of narcolepsy in the Danish population. Sleep 2010; 33:169-76. [PMID: 20175400 DOI: 10.1093/sleep/33.2.169] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
STUDY OBJECTIVES The International Classification of Sleep Disorders (ICSD-2) criteria for low CSF hypocretin-1 levels (CSF hcrt-1) still need validation as a diagnostic tool for narcolepsy in different populations because inter-assay variability and different definitions of hypocretin deficiency complicate direct comparisons of study results. DESIGN AND PARTICIPANTS Interviews, polysomnography, multiple sleep latency test, HLA-typing, and CSF hcrt-1 measurements in Danish patients with narcolepsy with cataplexy (NC) and narcolepsy without cataplexy (NwC), CSF hcrt-1 measurements in other hypersomnias, neurological and normal controls. Comparisons of hypocretin deficiency and frequency of HLA-DQB1*0602-positivity in the Danish and eligible NC and NwC populations (included via MEDLINE search), by (re)calculation of study results using the ICSD-2 criterion for low CSF hcrt-1 (< 30% of normal mean). MEASUREMENTS AND RESULTS In Danes, low CSF hcrt-1 was present in 40/46 NC, 3/14 NwC and 0/106 controls (P < 0.0001). Thirty-nine of 41 NC and 4/13 NwC patients were HLA-DQB1*0602-positive (P < 0.01). Hypocretin-deficient NC patients had higher frequency of cataplexy, shorter mean sleep latency, more sleep onset REM periods (P < 0.05) and more awakenings (NS) than did NC patients with normal CSF hcrt-1. Across populations, low CSF hcrt-1 and HLA-DQB1*0602-positivity characterized the majority of NC (80% to 100%, P = 0.53; 80% to 100%, P = 0.11) but a minority of NwC patients (11% to 29%, P = 0.75; 29% to 89%, P = 0.043). CONCLUSION The study provides evidence that hypocretin deficiency causes a more severe NC phenotype. The ICSD-2 criterion for low CSF hcrt-1 (< 30% of normal mean) is valid for diagnosing NC, but not NwC. HLA-typing should precede CSF hcrt-1 measurements because hypocretin deficiency is rare in HLA-DQB1*0602-negative patients.
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Affiliation(s)
- Stine Knudsen
- Danish Center for Sleep Medicine, University of Copenhagen, Glostrup Hospital, Glostrup, Denmark.
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CSF hypocretin-1 concentrations correlate with the level of fatigue in multiple sclerosis patients. Neurosci Lett 2010; 474:9-12. [PMID: 20193740 DOI: 10.1016/j.neulet.2010.02.062] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2010] [Revised: 02/16/2010] [Accepted: 02/22/2010] [Indexed: 01/21/2023]
Abstract
Considering the multiplicity of symptoms associated with multiple sclerosis (MS), there is possibility that hypocretin system function might be involved in the pathogenesis of the disease. The current study aimed to investigate the hypocretin-1 levels in cerebrospinal fluid (CSF) of MS patients in relation to different neurological deficit measures including: Ambulation Index (AI), Expanded Disability Status Scale (EDSS), Fatigue Severity Scale (FSS), and Epworth Sleepiness Scale (ESS) in relapse-onset MS patients. 53 subjects were included into the study: 38 patients with a diagnosis of MS and 15 healthy controls. Among MS patients, 25 had relapsing-remitting and 13 secondary progressive MS. CSF hypocretin-1 levels did not differ between MS patients and healthy controls (p>0.05). A positive correlation between hypocretin-1 level and fatigue level was found in MS patients (p<0.05) and this effect was even stronger in the MS subgroup suffering from fatigue (p=0.01). Hypocretin system seems to be generally unchanged in MS but a positive correlation between hypocretin-1 level and fatigue may indicate involvement of some compensatory mechanisms stimulating the production of the neuropeptide in MS patients.
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