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Wada M, Mimura M, Noda Y, Takasu S, Plitman E, Honda M, Natsubori A, Ogyu K, Tarumi R, Graff-Guerrero A, Nakajima S. Neuroimaging correlates of narcolepsy with cataplexy: A systematic review. Neurosci Res 2018; 142:16-29. [PMID: 29580887 DOI: 10.1016/j.neures.2018.03.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 03/15/2018] [Accepted: 03/22/2018] [Indexed: 11/29/2022]
Abstract
Recent developments in neuroimaging techniques have advanced our understanding of biological mechanisms underpinning narcolepsy. We used MEDLINE to retrieve neuroimaging studies to compare patients with narcolepsy and healthy controls. Thirty-seven studies were identified and demonstrated several replicated abnormalities: (1) gray matter reductions in superior frontal, superior and inferior temporal, and middle occipital gyri, hypothalamus, amygdala, insula, hippocampus, cingulate cortex, thalamus, and nucleus accumbens, (2) decreased fractional anisotropy in white matter of fronto-orbital and cingulate area, (3) reduced brain metabolism or cerebral blood flow in middle and superior frontal, and cingulate cortex (4) increased activity in inferior frontal gyri, insula, amygdala, and nucleus accumbens, and (5) N-acetylaspartate/creatine-phosphocreatine level reduction in hypothalamus. In conclusion, all the replicated findings are still controversial due to the limitations such as heterogeneity or size of the samples and lack of multimodal imaging or follow-up. Thus, future neuroimaging studies should employ multimodal imaging methods in a large sample size of patients with narcolepsy and consider age, duration of disease, age at onset, severity, human leukocyte antigen type, cerebrospinal fluid hypocretin levels, and medication intake in order to elucidate possible neuroimaging characteristic of narcolepsy and identify therapeutic targets.
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Affiliation(s)
- Masataka Wada
- Department of Neuropsychiatry, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
| | - Masaru Mimura
- Department of Neuropsychiatry, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
| | - Yoshihiro Noda
- Department of Neuropsychiatry, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
| | - Shotaro Takasu
- Department of Neuropsychiatry, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
| | - Eric Plitman
- Multimodal Imaging Group - Research Imaging Centre, Centre for Addiction and Mental Health, 250 College, Toronto, Ontario, M5T 1R8, Canada; Institute of Medical Science, University of Toronto, 1 King's College Circle, Toronto, Ontario, M5S 1A8, Canada.
| | - Makoto Honda
- Tokyo Metropolitan Institute of Medical Science, 2-1-6 Kamikitazawa, Setagaya-ku, Tokyo, 156-8506, Japan; Seiwa Hospital, 91 Bententyo, Sinjyuku-ku, Tokyo, 162-0851, Japan.
| | - Akiyo Natsubori
- Tokyo Metropolitan Institute of Medical Science, 2-1-6 Kamikitazawa, Setagaya-ku, Tokyo, 156-8506, Japan.
| | - Kamiyu Ogyu
- Department of Neuropsychiatry, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
| | - Ryosuke Tarumi
- Department of Neuropsychiatry, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
| | - Ariel Graff-Guerrero
- Multimodal Imaging Group - Research Imaging Centre, Centre for Addiction and Mental Health, 250 College, Toronto, Ontario, M5T 1R8, Canada; Geriatric Mental Health Division, Centre for Addiction and Mental Health, 80 Workman Way, Toronto, Ontario, M6J 1H4, Canada; Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario, M5T 1R8, Canada.
| | - Shinichiro Nakajima
- Department of Neuropsychiatry, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan; Multimodal Imaging Group - Research Imaging Centre, Centre for Addiction and Mental Health, 250 College, Toronto, Ontario, M5T 1R8, Canada; Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario, M5T 1R8, Canada.
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Weng HH, Chen CF, Tsai YH, Wu CY, Lee M, Lin YC, Yang CT, Tsai YH, Yang CY. Gray matter atrophy in narcolepsy: An activation likelihood estimation meta-analysis. Neurosci Biobehav Rev 2015; 59:53-63. [PMID: 25825285 DOI: 10.1016/j.neubiorev.2015.03.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 02/07/2015] [Accepted: 03/19/2015] [Indexed: 12/17/2022]
Abstract
The authors reviewed the literature on the use of voxel-based morphometry (VBM) in narcolepsy magnetic resonance imaging (MRI) studies via the use of a meta-analysis of neuroimaging to identify concordant and specific structural deficits in patients with narcolepsy as compared with healthy subjects. We used PubMed to retrieve articles published between January 2000 and March 2014. The authors included all VBM research on narcolepsy and compared the findings of the studies by using gray matter volume (GMV) or gray matter concentration (GMC) to index differences in gray matter. Stereotactic data were extracted from 8 VBM studies of 149 narcoleptic patients and 162 control subjects. We applied activation likelihood estimation (ALE) technique and found significant regional gray matter reduction in the bilateral hypothalamus, thalamus, globus pallidus, extending to nucleus accumbens (NAcc) and anterior cingulate cortex (ACC), left mid orbital and rectal gyri (BAs 10 and 11), right inferior frontal gyrus (BA 47), and the right superior temporal gyrus (BA 41) in patients with narcolepsy. The significant gray matter deficits in narcoleptic patients occurred in the bilateral hypothalamus and frontotemporal regions, which may be related to the emotional processing abnormalities and orexin/hypocretin pathway common among populations of patients with narcolepsy.
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Affiliation(s)
- Hsu-Huei Weng
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chiayi, Chang Gung University College of Medicine, Taiwan; Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan; Department of Psychology, National Chung Cheng University, Chiayi, Taiwan
| | - Chih-Feng Chen
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chiayi, Chang Gung University College of Medicine, Taiwan
| | - Yuan-Hsiung Tsai
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chiayi, Chang Gung University College of Medicine, Taiwan
| | - Chih-Ying Wu
- Department of Neurology, Chang Gung Memorial Hospital, Chiayi, Chang Gung University College of Medicine, Taiwan
| | - Meng Lee
- Department of Neurology, Chang Gung Memorial Hospital, Chiayi, Chang Gung University College of Medicine, Taiwan
| | - Yu-Ching Lin
- Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan; Division of Pulmonary and Critical Care Medicine and Department of Respiratory Care, Chang Gung Memorial Hospital, Chiayi, Taiwan; Department of Respiratory Care, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Cheng-Ta Yang
- Division of Pulmonary and Critical Care Medicine of Chang Gung Memorial Hospital, Chiayi, Taiwan; Department of Respiratory Care, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ying-Huang Tsai
- Division of Pulmonary and Critical Care Medicine of Chang Gung Memorial Hospital, Chiayi, Taiwan; Department of Respiratory Therapy, Chang Gung University, Taoyuan, Taiwan.
| | - Chun-Yuh Yang
- Faculty of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan
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3
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Development and Impact of Brain Imaging Techniques. Sleep Med 2015. [DOI: 10.1007/978-1-4939-2089-1_64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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4
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Abstract
Various brain imaging techniques have been used to study narcolepsy with cataplexy. Anatomical data with magnetic resonance imaging have characterized specific alterations in grey and white matter and their potential implications on disease severity. Functional neuroimaging studies have described changes in brain perfusion or glucose metabolism during resting wakefulness, as well as brain responses to emotional stimulation in narcoleptic patients. These different imaging modalities provide evidence for structural and functional abnormalities compatible with a deficit in the hypocretinergic system. They also indicate the involvement of other neural structures, such as the amygdala, nucleus accumbens, midbrain, thalamus, hippocampus, and fronto-temporal cortical areas. This article reviews the contribution of neuroimaging to the pathophysiology of narcolepsy with cataplexy, focusing on the most recent developments.
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Affiliation(s)
- Thien Thanh Dang-Vu
- Department of Exercise Science, Concordia University, 7141 Sherbrooke St W, Room SP 165.27, Montréal, Québec, H4B 1R6, Canada.
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Desseilles M, Dang-Vu T, Maquet P. Functional neuroimaging in sleep, sleep deprivation, and sleep disorders. HANDBOOK OF CLINICAL NEUROLOGY 2011; 98:71-94. [DOI: 10.1016/b978-0-444-52006-7.00006-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Abstract
Narcolepsy is a lifelong sleep disorder characterized by a classic tetrad of excessive daytime sleepiness with irresistible sleep attacks, cataplexy (sudden bilateral loss of muscle tone), hypnagogic hallucination, and sleep paralysis. There are two distinct groups of patients, ie, those having narcolepsy with cataplexy and those having narcolepsy without cataplexy. Narcolepsy affects 0.05% of the population. It has a negative effect on the quality of life of its sufferers and can restrict them from certain careers and activities. There have been advances in the understanding of the pathogenesis of narcolepsy. It is thought that narcolepsy with cataplexy is secondary to loss of hypothalamic hypocretin neurons in those genetically predisposed to the disorder by possession of human leukocyte antigen DQB1*0602. The diagnostic criteria for narcolepsy are based on symptoms, laboratory sleep tests, and serum levels of hypocretin. There is no cure for narcolepsy, and the present mainstay of treatment is pharmacological treatment along with lifestyle changes. Some novel treatments are also being developed and tried. This article critically appraises the evidence for diagnosis and treatment of narcolepsy.
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Stepień A, Staszewski J, Domzał TM, Tomczykiewicz K, Skrobowska E, Durka-Kesy M. Degenerative pontine lesions in patients with familial narcolepsy. Neurol Neurochir Pol 2010; 44:21-7. [PMID: 20358482 DOI: 10.1016/s0028-3843(14)60403-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND AND PURPOSE Narcolepsy is characterized by chronic excessive daytime sleepiness with episodic sleep attacks. There are several associated symptoms of narcolepsy: cataplexy (bilateral muscle weakness without loss of consciousness provoked by an emotional trigger, e.g. laughter), sleep paralysis and hypnagogic-hypnopompic hallucinations. Most cases are sporadic; familial narcolepsy contributes to only 1-5% of all cases. While most cases of narcolepsy are idiopathic and are not associated with clinical or radiographic evidence of brain pathology, symptomatic or secondary narcolepsy may occur occasionally in association with lesions caused by tumours, demyelination or strokes of the diencephalon, midbrain, and pons. There are some examples of non-specific brainstem lesions found in magnetic resonance imaging (MRI) in patients with idiopathic narcolepsy. MATERIAL AND METHODS The authors present eleven patients from a five-generation family with many members who suffer from episodic excessive daytime sleepiness. Narcolepsy was diagnosed in 9 patients. Sleepiness was frequently associated with cataplexy, hypnagogic-hypnopompic hallucinations and sleep paralysis. Improvement in their clinical state was observed during the treatment with modafinil. All probands had MRI of the brain, routine blood tests, EEG, polysomnography, examination of the level of hypocretin in cerebrospinal fluid and evaluation by means of Epworth and Stanford Sleepiness Scales. RESULTS In 9 patients with narcolepsy, decreased thickness of the substantia nigra was found and in six of them degenerative lesions in the pontine substantia nigra were also noticed. CONCLUSIONS The significance of these changes remains unclear. No data have been published until now concerning the presence of any brain lesions in patients with familial narcolepsy.
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Affiliation(s)
- Adam Stepień
- Clinic of Neurology, Military Medical Institute, Szaserów St., Warsaw, Poland.
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8
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Tonon C, Franceschini C, Testa C, Manners DN, Poli F, Mostacci B, Mignot E, Montagna P, Barbiroli B, Lodi R, Plazzi G. Distribution of neurochemical abnormalities in patients with narcolepsy with cataplexy: An in vivo brain proton MR spectroscopy study. Brain Res Bull 2009; 80:147-50. [DOI: 10.1016/j.brainresbull.2009.05.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2009] [Revised: 05/12/2009] [Accepted: 05/12/2009] [Indexed: 12/24/2022]
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Poryazova R, Schnepf B, Werth E, Khatami R, Dydak U, Meier D, Boesiger P, Bassetti CL. Evidence for metabolic hypothalamo-amygdala dysfunction in narcolepsy. Sleep 2009; 32:607-13. [PMID: 19480227 DOI: 10.1093/sleep/32.5.607] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
STUDY OBJECTIVES Proton resonance spectroscopy (1H-MRS) allows noninvasive chemical tissue analysis in the living brain. As neuronal loss and gliosis have been described in narcolepsy, metabolites of primary interest are N-acetylaspartate (NAA), a marker of neuronal integrity and myo-Inositol (ml), a glial marker and second messenger involved in the regulation of intracellular calcium. One 1H-MRS study in narcolepsy found no metabolic changes in the pontomedullary junction. Another study showed a reduction in NAA/creatine-phosphocreatine (Cr) in the hypothalamus of narcolepsy patients with cataplexy. We aimed to test for metabolic changes in specific brain areas, "regions of interest," thought to be involved in emotional processing, sleep regulation and pathophysiology of narcolepsy: hypothalamus, pontomesencephalic junction and both amygdalae. DESIGN We performed 1H-MRS using a 3T Philips Achieva whole body MR scanner. Single-voxel proton MR spectra were acquired and quantified with LCModel to determine metabolite concentration ratios. SETTING The participants in the study were recruited at the outpatient clinic for sleep medicine, Department of Neurology and magnetic resonance spectroscopy was performed at the MRI facility, University Hospital Zurich. PARTICIPANTS 1H-MRS was performed in fourteen narcolepsy patients with cataplexy, CSF hypocretin deficiency (10/10) and HLA-DQB1*0602 positivity (14/14) and 14 age, gender and body mass index matched controls. Patients were treatment naïve or off therapy for at least 14 days before scanning. MEASUREMENTS AND RESULTS No differences were observed in the regions of interest for (total NAA)/Cr ratios. Myo-Inositol (ml)/Cr was significantly lower in the right amygdala of the patients, compared to controls (P < 0.042). Significant negative correlations only in the patients group were found between (total NAA)/Cr in hypothalamus and ml/Cr in the right amygdala (r = -0.89, P < 0.001), between ml/Cr in hypothalamus and (total NAA)/Cr in the right amygdala (r = -63, P < 0.05) and between ml/Cr in the left amygdala and total NAA)/Cr in the pontomesencephalic junction (r = -0.69, P < 0.05). CONCLUSION Our findings suggest amygdala involvement and possible hypothalamo-amygdala dysfunction in narcolepsy.
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Affiliation(s)
- Rositsa Poryazova
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland
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10
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Peterson PC, Husain AM. Pediatric narcolepsy. Brain Dev 2008; 30:609-23. [PMID: 18375081 DOI: 10.1016/j.braindev.2008.02.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2007] [Revised: 01/25/2008] [Accepted: 02/03/2008] [Indexed: 11/24/2022]
Abstract
Narcolepsy is a disabling disease with a prevalence of 0.05%. It is characterized by excessive daytime sleepiness, cataplexy, sleep paralysis, hypnogogic hallucinations, automatic behavior, and disrupted nocturnal sleep. The presentation can be very variable, making diagnosis difficult. Loss of hypocretin containing neurons in the lateral hypothalamus has been noted in autopsy studies, and the cerebrospinal fluid level of hypocretin is reduced in patients with narcolepsy with cataplexy. New treatment options are available for the many symptoms of this disease. Early recognition and treatment can greatly improve the quality of life of patients with narcolepsy. A detail review of the epidemiology, pathophysiology, and management of narcolepsy in children is presented.
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Affiliation(s)
- Paul C Peterson
- Department of Medicine (Neurology), Duke University Medical Center, 202 Bell Building, Box 3678, Durham, NC 27710, USA
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11
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Khatami R, von Büdingen HC, Bassetti CL. Sleep–Wake Disturbances in Neurologic Autoimmune Disorders. Sleep Med Clin 2008. [DOI: 10.1016/j.jsmc.2008.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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12
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Desseilles M, Dang-Vu T, Schabus M, Sterpenich V, Maquet P, Schwartz S. Neuroimaging insights into the pathophysiology of sleep disorders. Sleep 2008; 31:777-94. [PMID: 18548822 PMCID: PMC2442420 DOI: 10.1093/sleep/31.6.777] [Citation(s) in RCA: 118] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Neuroimaging methods can be used to investigate whether sleep disorders are associated with specific changes in brain structure or regional activity. However, it is still unclear how these new data might improve our understanding of the pathophysiology underlying adult sleep disorders. Here we review functional brain imaging findings in major intrinsic sleep disorders (i.e., idiopathic insomnia, narcolepsy, and obstructive sleep apnea) and in abnormal motor behavior during sleep (i.e., periodic limb movement disorder and REM sleep behavior disorder). The studies reviewed include neuroanatomical assessments (voxel-based morphometry, magnetic resonance spectroscopy), metabolic/functional investigations (positron emission tomography, single photon emission computed tomography, functional magnetic resonance imaging), and ligand marker measurements. Based on the current state of the research, we suggest that brain imaging is a useful approach to assess the structural and functional correlates of sleep impairments as well as better understand the cerebral consequences of various therapeutic approaches. Modem neuroimaging techniques therefore provide a valuable tool to gain insight into possible pathophysiological mechanisms of sleep disorders in adult humans.
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Kim SJ, Lyoo IK, Lee YS, Sung YH, Kim HJ, Kim JH, Kim KH, Jeong DU. Increased GABA levels in medial prefrontal cortex of young adults with narcolepsy. Sleep 2008; 31:342-7. [PMID: 18363310 DOI: 10.1093/sleep/31.3.342] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
STUDY OBJECTIVES To explore absolute concentrations of brain metabolites including gamma amino-butyric acid (GABA) in the medial prefrontal cortex and basal ganglia of young adults with narcolepsy. DESIGN Proton magnetic resonance (MR) spectroscopy centered on the medial prefrontal cortex and the basal ganglia was acquired. The absolute concentrations of brain metabolites including GABA and glutamate were assessed and compared between narcoleptic patients and healthy comparison subjects. SETTING Sleep and Chronobiology Center at Seoul National University Hospital; A high strength 3.0 Tesla MR scanner in the Department of Radiology at Seoul National University Hospital. PATIENTS OR PARTICIPANTS Seventeen young adults with a sole diagnosis of HLA DQB1 0602 positive narcolepsy with cataplexy (25.1 +/- 4.6 years old) and 17 healthy comparison subjects (26.8 +/- 4.8 years old). INTERVENTIONS N/A. MEASUREMENTS AND RESULTS Relative to comparison subjects, narcoleptic patients had higher GABA concentration in the medial prefrontal cortex (t = 4.10, P <0.001). Narcoleptic patients with nocturnal sleep disturbance had higher GABA concentration in the medial prefrontal cortex than those without nocturnal sleep disturbance (t = 2.45, P = 0.03), but had lower GABA concentration than comparison subjects (t = 2.30, P = 0.03). CONCLUSIONS The current study reports that young adults with narcolepsy had a higher GABA concentration in the medial prefrontal cortex, which was more prominent in patients without nocturnal sleep disturbance. Our findings suggest that the medial prefrontal GABA level may be increased in narcolepsy, and the increased medial prefrontal GABA might be a compensatory mechanism to reduce nocturnal sleep disturbances in narcolepsy.
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Affiliation(s)
- Seog Ju Kim
- Department of Psychiatry, Gachon University of Medicine and Science, Incheon, South Korea
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14
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Hanoglu L, Ozer F, Meral H, Dincer A. Brainstem 1H-MR spectroscopy in patients with Parkinson's disease with REM sleep behavior disorder and IPD patients without dream enactment behavior. Clin Neurol Neurosurg 2005; 108:129-34. [PMID: 15936138 DOI: 10.1016/j.clineuro.2005.03.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2004] [Revised: 03/01/2005] [Accepted: 03/13/2005] [Indexed: 11/20/2022]
Abstract
OBJECTIVES The objective of our study was to evaluate brainstem involvement by 1H-MR spectroscopy (1H-MRS) method in patients with idiopathic Parkinson's disease (IPD) with REM sleep behavior disorder (RBD) and IPD without dream enactment behavior. PATIENTS AND METHODS We prospectively studied 12 IPD (3 females, 9 males) with a clinically and electrophysiologically confirmed RBD and 12 IPD (3 females, 9 males) patients without dream enactment behavior followed in Outpatient Clinics for Movement Disorders of Department of Neurology, Haseki Hospital. Using long and short TE single voxel 1H-MRS directed at ventral and dorsal pons, long TE NAA/Cr, Ch/Cr and short TE NAA/Cr, Ch/Cr, MI/Cr values of both groups were compared. RESULTS Although no difference was found between groups with RBD and IPD without dream enactment behavior in demographic characteristics, duration of disease, mean levodopa dosage and duration of levodopa use, all UPDRS scores (total, motor and cognitive) were worse in RBD group (p<0.05). There was no statistically significant difference in long TE NAA/Cr, Ch/Cr and short TE NAA/Cr, Ch/Cr, MI/Cr values obtained in both groups (p>0.05). CONCLUSION 1H-MRS does not detect marked metabolic differences in the pons in subjects with IPD with RBD and IPD without dream enactment behavior. This finding suggests either that present methodologies are not sensitive to detect subtle metabolic changes in the pons of subjects with RBD or that the primary lesion of RBD exists in other REM sleep-related brain regions beyond the pons such as the substantia nigra, the basal ganglia or the limbic system.
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Affiliation(s)
- Lutfu Hanoglu
- Department of Neurology, Bakirkoy Neurology Center, Turkey
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15
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Moreno-Torres A, Pujol J, Soriano-Mas C, Deus J, Iranzo A, Santamaria J. Age-related metabolic changes in the upper brainstem tegmentum by MR spectroscopy. Neurobiol Aging 2004; 26:1051-9. [PMID: 15748785 DOI: 10.1016/j.neurobiolaging.2004.09.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2004] [Revised: 08/02/2004] [Accepted: 09/22/2004] [Indexed: 11/21/2022]
Abstract
Several neurodegenerative disorders have a profound metabolic and structural impact on the brainstem. MR spectroscopy provides metabolic information non-invasively and has the potential to characterize the changes associated with normal aging and differentiate them from neurodegenerative alterations. The present work was aimed at studying the upper brainstem tegmentum at the midbrain and pontine levels in 57 adult normal volunteers, aged 23-79 years, with long-echo time proton MR spectroscopy to evaluate possible regional differences and the effect of age. Higher ratios of N-acetyl aspartate (NAA)/total creatine (Cr) and choline-containing compounds (Cho)/Cr were observed in the pons compared to the midbrain, resulting from higher net NAA and Cho content. In the midbrain, there was a linear decline of NAA and Cho with age in subjects over 50, most probably related to neuronal tissue loss. In the pons, such an aging effect was not observed, with subjects over 50 showing higher Cr and Cho than the under-50 subjects. Our findings provided evidence of regional differences and suggest different effects of age on the two studied brainstem segments, hitherto undescribed.
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Affiliation(s)
- Angel Moreno-Torres
- Research Department, Centre Diagnòstic Pedralbes, 08950, Esplugues de Llobregat, Spain.
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16
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Overeem S, Mignot E, van Dijk JG, Lammers GJ. Narcolepsy: clinical features, new pathophysiologic insights, and future perspectives. J Clin Neurophysiol 2001; 18:78-105. [PMID: 11435802 DOI: 10.1097/00004691-200103000-00002] [Citation(s) in RCA: 236] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Narcolepsy is characterized by excessive daytime sleepiness and abnormal manifestations of rapid eye movement sleep such as cataplexy. The authors review the clinical features of narcolepsy, including epidemiology, symptoms, diagnosis, and treatment, in detail. Recent findings show that a loss of hypocretin-producing neurons lies at the root of the signs and symptoms of narcolepsy. The authors review the current state of knowledge on hypocretin anatomy, physiology, and function with special emphasis on the research regarding the hypocretin deficiency in narcolepsy, which may also explain associated features of the disorder, such as obesity. Lastly, they discuss some future perspectives for research into the pathophysiology of sleep/wake disorders, and the potential impact of the established hypocretin deficiency on the diagnosis and treatment of narcolepsy.
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Affiliation(s)
- S Overeem
- Department of Neurology and Clinical Neurophysiology, Leiden University Medical Center, The Netherlands
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17
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Chemelli RM, Willie JT, Sinton CM, Elmquist JK, Scammell T, Lee C, Richardson JA, Williams SC, Xiong Y, Kisanuki Y, Fitch TE, Nakazato M, Hammer RE, Saper CB, Yanagisawa M. Narcolepsy in orexin knockout mice: molecular genetics of sleep regulation. Cell 1999; 98:437-51. [PMID: 10481909 DOI: 10.1016/s0092-8674(00)81973-x] [Citation(s) in RCA: 1869] [Impact Index Per Article: 74.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Neurons containing the neuropeptide orexin (hypocretin) are located exclusively in the lateral hypothalamus and send axons to numerous regions throughout the central nervous system, including the major nuclei implicated in sleep regulation. Here, we report that, by behavioral and electroencephalographic criteria, orexin knockout mice exhibit a phenotype strikingly similar to human narcolepsy patients, as well as canarc-1 mutant dogs, the only known monogenic model of narcolepsy. Moreover, modafinil, an anti-narcoleptic drug with ill-defined mechanisms of action, activates orexin-containing neurons. We propose that orexin regulates sleep/wakefulness states, and that orexin knockout mice are a model of human narcolepsy, a disorder characterized primarily by rapid eye movement (REM) sleep dysregulation.
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Affiliation(s)
- R M Chemelli
- Howard Hughes Medical Institute, Department of Molecular Genetics, University of Texas Southwestern Medical Center at Dallas, 75235-9050, USA
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