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Wenhong C, Xiaoying M, Lingli S, Binyun T, Yining W, Mingming Z, Yian L, Lixia Q, Wenyu H, Fengjin P. Assessing resting-state brain functional connectivity in adolescents and young adults with narcolepsy using functional near-infrared spectroscopy. Front Hum Neurosci 2024; 18:1373043. [PMID: 38606200 PMCID: PMC11007108 DOI: 10.3389/fnhum.2024.1373043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 03/13/2024] [Indexed: 04/13/2024] Open
Abstract
This study aimed to elucidate the alterations in the prefrontal cortex's functional connectivity and network topology in narcolepsy patients using functional near-infrared spectroscopy (fNIRS). Twelve narcolepsy-diagnosed patients from Guangxi Zhuang Autonomous Region's People's Hospital Sleep Medicine Department and 11 matched healthy controls underwent resting fNIRS scans. Functional connectivity and graph theory analyses were employed to assess the prefrontal cortex network's properties and their correlation with clinical features. Results indicated increased functional connectivity in these adolescent and young adult patients with narcolepsy, with significant variations in metrics like average degree centrality and node efficiency, particularly in the left middle frontal gyrus. These alterations showed correlations with clinical symptoms, including depression and sleep efficiency. However, the significance of these findings was reduced post False Discovery Rate adjustment, suggesting a larger sample size is needed for validation. In conclusion, the study offers initial observations that alterations in the prefrontal cortex's functional connectivity may potentially act as a neurobiological indicator of narcolepsy, warranting further investigation with a larger cohort to substantiate these findings and understand the underlying mechanisms.
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Affiliation(s)
- Chen Wenhong
- Department of Sleep Medicine, The People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Mo Xiaoying
- Department of Sleep Medicine, The People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Shi Lingli
- Department of Sleep Medicine, The People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Tang Binyun
- Department of Sleep Medicine, The People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Wen Yining
- Department of Sleep Medicine, The People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Zhao Mingming
- Department of Sleep Medicine, The People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Lu Yian
- Department of Sleep Medicine, The People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Qin Lixia
- Guangxi Clinical Reserch Center for Sleep Medicine, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Hu Wenyu
- Department of Sleep Medicine, The People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Pan Fengjin
- Department of Sleep Medicine, The People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
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Dye TJ. Clinical Evaluation and Management of Narcolepsy in Children and Adolescents. Semin Pediatr Neurol 2023; 48:101089. [PMID: 38065636 DOI: 10.1016/j.spen.2023.101089] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/26/2023] [Accepted: 09/26/2023] [Indexed: 12/18/2023]
Abstract
While sleepiness is common among children, and particularly adolescents, profound sleepiness in the setting of apparently adequate sleep should prompt consideration of a central disorder of hypersomnolence. These disorders, which include narcolepsy, idiopathic hypersomnia, Kleine-Levin syndrome, and others, are likely underrecognized in the pediatric population. Narcolepsy in particular should be of interest to child neurologists as the unique signs and symptoms of this disease often prompt evaluation in pediatric neurology clinics. While sleepiness may appear to be a straightforward complaint, its evaluation requires a nuanced approach. Cataplexy, a hallmark of narcolepsy, can be confused for other neurologic conditions, though understanding its various manifestations makes it readily identifiable. Clinicians should be aware of these symptoms, as delay in diagnosis and misdiagnosis are common in childhood narcolepsy. While treatment options have been limited in the past, many new therapeutic options have become available and can result in significant improvement in symptoms. Given the age at presentation, paroxysmal and chronic features, diagnostic modalities, and available treatment options, the field of child neurology is well equipped to see patients with narcolepsy. In this review, I will focus on the presentation, evaluation, and management of pediatric patients with narcolepsy.
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Affiliation(s)
- Thomas J Dye
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Division of Pulmonary - Sleep Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH.
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Triller A, Pizza F, Lecendreux M, Lieberich L, Rezaei R, Pech de Laclause A, Vandi S, Plazzi G, Kallweit U. Real-world treatment of pediatric narcolepsy with pitolisant: A retrospective, multicenter study. Sleep Med 2023; 103:62-68. [PMID: 36758348 DOI: 10.1016/j.sleep.2023.01.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 01/11/2023] [Accepted: 01/20/2023] [Indexed: 01/26/2023]
Abstract
BACKGROUND First symptoms of narcolepsy mostly present during childhood. Pharmacological management options in children are limited, also due to approval status. Pitolisant is an inverse histamine 3 receptor agonist and has been approved for the treatment of adult narcolepsy with or without cataplexy by EMA and FDA. Clinical experience indicates for a beneficial use also in children and adolescents. Our goal was to evaluate the effects and tolerability of pitolisant in narcolepsy children/adolescents in a real-world setting. METHODS This multicentre retrospective observational study included 55 patients with narcolepsy from three international narcolepsy centers (Germany, France and Italy) who were treated with pitolisant. Patients were eligible if they were at least 6 years old and diagnosed with narcolepsy type 1 or 2. Demographic and clinical characteristics, questionnaires, sleep medicine and laboratory data were collected. RESULTS 55 children/adolescents (25 girls, 45.45%, 30 boys, 54.55%) aged 6-18 years, with narcolepsy (type 1 = 92.7%, type 2 = 7.3%), were treated with pitolisant. The mean pitolisant dose was 34.1 mg/d. Treatment was effective for excessive daytime sleepiness (EDS) and cataplexy: the pediatric Epworth Sleepiness Scale (ESS) score decreased from 19 to 13.5 (p < 0.001) and the weekly cataplexy frequency improved from 7.9 at baseline to 5.2 (p < 0.001). Treatment with pitolisant was well tolerated. Side effects were mild and mostly short-term. Insomnia was reported most frequently (5.5%). CONCLUSION First real-world results suggest that pitolisant treatment is effective in improving EDS and cataplexy in children with narcolepsy, and also is well tolerated.
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Affiliation(s)
- Annika Triller
- Center for Narcolepsy and Hypersomnias, Clinical Sleep and Neuroimmunology, Institute of Immunology, University of Witten/Herdecke, Witten, Germany
| | - Fabio Pizza
- Department of Biomedical Science and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy; IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Michel Lecendreux
- Pediatric Sleep Centre, Robert Debre Hospital, Paris, France; Reference Center for Narcolepsy and Hypersomnias, Robert Debre Hospital, Paris, France
| | - Lea Lieberich
- Center for Narcolepsy and Hypersomnias, Clinical Sleep and Neuroimmunology, Institute of Immunology, University of Witten/Herdecke, Witten, Germany
| | - Rana Rezaei
- Center for Narcolepsy and Hypersomnias, Clinical Sleep and Neuroimmunology, Institute of Immunology, University of Witten/Herdecke, Witten, Germany
| | - Anna Pech de Laclause
- Pediatric Sleep Centre, Robert Debre Hospital, Paris, France; Reference Center for Narcolepsy and Hypersomnias, Robert Debre Hospital, Paris, France
| | - Stefano Vandi
- Department of Biomedical Science and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy; IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Giuseppe Plazzi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy; Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Ulf Kallweit
- Center for Narcolepsy and Hypersomnias, Clinical Sleep and Neuroimmunology, Institute of Immunology, University of Witten/Herdecke, Witten, Germany.
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Precocious puberty in narcolepsy type 1: Orexin loss and/or neuroinflammation, which is to blame? Sleep Med Rev 2022; 65:101683. [PMID: 36096986 DOI: 10.1016/j.smrv.2022.101683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 07/20/2022] [Accepted: 07/25/2022] [Indexed: 10/14/2022]
Abstract
Narcolepsy type 1 (NT1) is a rare neurological sleep disorder triggered by postnatal loss of the orexin/hypocretin neuropeptides. Overweight/obesity and precocious puberty are highly prevalent comorbidities of NT1, with a close temporal correlation with disease onset, suggesting a common origin. However, the underlying mechanisms remain unknown and merit further investigation. The main question we address in this review is whether the occurrence of precocious puberty in NT1 is due to the lack of orexin/hypocretin or rather to a wider hypothalamic dysfunction in the context of neuroinflammation, which is likely to accompany the disease given its autoimmune origins. Our analysis suggests that the suspected generalized neuroinflammation of the hypothalamus in NT1 would tend to delay puberty rather than hastening it. In contrast, that the brutal loss of orexin/hypocretin would favor an early reactivation of gonadotropin-releasing hormone (GnRH) secretion during the prepubertal period in vulnerable children, leading to early puberty onset. Orexin/hypocretin replacement could thus be envisaged as a potential treatment for precocious puberty in NT1. Additionally, we put forward an alternative hypothesis regarding the concomitant occurrence of sleepiness, weight gain and early puberty in NT1.
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Lividini A, Pizza F, Filardi M, Vandi S, Ingravallo F, Antelmi E, Bruni O, Cosentino FII, Ferri R, Guarnieri B, Marelli S, Ferini-Strambi L, Romigi A, Bonanni E, Maestri M, Terzaghi M, Manni R, Plazzi G. Narcolepsy type 1 features across the life span: age impact on clinical and polysomnographic phenotype. J Clin Sleep Med 2021; 17:1363-1370. [PMID: 33666167 DOI: 10.5664/jcsm.9198] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
STUDY OBJECTIVES Narcolepsy type 1 (NT1) is a chronic neurological disorder typically arising during adolescence and young adulthood. Recent studies demonstrated that NT1 presents with age-specific features, especially in children. With this study we aimed to describe and to compare the clinical pictures of NT1 in different age groups. METHODS In this cross-sectional, multicenter study, 106 untreated patients with NT1 enrolled at the time of diagnosis underwent clinical evaluation, a semistructured interview (including the Epworth Sleepiness Scale), nocturnal video-polysomnography, and the Multiple Sleep Latency Test. Patients were enrolled in order to establish 5 age-balanced groups (childhood, adolescence, adulthood, middle age, and senior). RESULTS The Epworth Sleepiness Scale score showed a significant increase with age, while self-reported diurnal total sleep time was lower in older and young adults, with the latter also complaining of automatic behaviors in more than 90% of patients. Children reported the cataplexy attacks to be more frequent (> 1/d in 95% of patients). "Recalling an emotional event," "meeting someone unexpectedly," "stress," and "anger" were more frequently reported in adult and older adult patients as possible triggers of cataplexy. Neurophysiological data showed a higher number of sleep-onset rapid eye movement periods on the Multiple Sleep Latency Test in adolescent compared to senior patients and an age-progressive decline in sleep efficiency. CONCLUSIONS Daytime sleepiness, cataplexy features and triggers, and nocturnal sleep structure showed age-related difference in patients with NT1; this variability may contribute to diagnostic delay and misdiagnosis.
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Affiliation(s)
- Althea Lividini
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Fabio Pizza
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,IRCCS, Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Marco Filardi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Stefano Vandi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,IRCCS, Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Francesca Ingravallo
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Elena Antelmi
- Neurology Unit, Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Oliviero Bruni
- Department of Developmental and Social Psychology, Sapienza University of Rome, Italy
| | | | - Raffaele Ferri
- Sleep Research Center, Department of Neurology IC, Oasi Research Institute-IRCCS, Troina, Italy
| | - Biancamaria Guarnieri
- Center of Sleep Medicine, Department of Neurology, Villa Serena Hospital and Villa Serena Foundation for Research, Città S. Angelo, Pescara, Italy
| | - Sara Marelli
- Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Neurology-Sleep Disorders Centre, Milan, Italy
| | - Luigi Ferini-Strambi
- Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Neurology-Sleep Disorders Centre, Milan, Italy
| | - Andrea Romigi
- IRCCS Neuromed Istituto Neurologico Mediterraneo Sleep Medicine Centre, Pozzilli, Italy
| | - Enrica Bonanni
- Department of Clinical and Experimental Medicine, Neurology Unit, University of Pisa, Italy
| | - Michelangelo Maestri
- Department of Clinical and Experimental Medicine, Neurology Unit, University of Pisa, Italy
| | - Michele Terzaghi
- Unit of Sleep Medicine and Epilepsy, IRCCS Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Raffaele Manni
- Unit of Sleep Medicine and Epilepsy, IRCCS Mondino Foundation, Pavia, Italy
| | - Giuseppe Plazzi
- IRCCS, Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.,Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
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Prevalence of Depression or Depressive Symptoms in Patients with Narcolepsy: a Systematic Review and Meta-Analysis. Neuropsychol Rev 2020; 31:89-102. [PMID: 32671534 DOI: 10.1007/s11065-020-09443-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 06/22/2020] [Indexed: 02/05/2023]
Abstract
A meta-analysis was conducted to review the prevalence and associated moderators of depression or depressive symptoms in patients with narcolepsy. An extensive search of the literature yielded 1104 articles and abstracts, of which 31 studies were included in the meta-analysis. Meta-analysis revealed that the overall pooled prevalence of depression or depressive symptoms in patients with narcolepsy was 32% (95% Confidence Interval, 28-36%) with high between-study heterogeneity (Q = 249.77, df = 30, p < 0.001, τ2 = 0.0087, I2 = 88%). An analysis of 13 studies with healthy control groups indicated that narcolepsy was associated with a significantly increased risk of depression or depressive symptoms (Odds Ratio 3.48, 95% Confidence Interval 2.73-4.45; Q = 41.23, df = 12, p < 0.001, τ2 = 0.0087, I2 = 70.9%). The prevalence of depression or depressive symptoms in patients with narcolepsy was significantly affected by study design (Q = 5.05, p = 0.02) and recruitment setting (Q = 5.98, p = 0.01), and was marginally affected by age group (Q = 3.44, p = 0.06). The results indicate that narcolepsy patients should be closely monitored for depression and depressive symptoms and that early screening should be considered. However, these conclusions should be tempered because of high variability between studies. The estimates across studies are very inconsistent, indicating the need for larger, multicenter studies, with stringent case definitions.
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Fulong X, Spruyt K, Chao L, Dianjiang Z, Jun Z, Fang H. Resting-state brain network topological properties and the correlation with neuropsychological assessment in adolescent narcolepsy. Sleep 2020; 43:5734536. [PMID: 32047928 DOI: 10.1093/sleep/zsaa018] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 01/30/2020] [Indexed: 12/14/2022] Open
Abstract
Abstract
Study Objectives
To evaluate functional connectivity and topological properties of brain networks, and to investigate the association between brain topological properties and neuropsychiatric behaviors in adolescent narcolepsy.
Methods
Resting-state functional magnetic resonance imaging (fMRI) and neuropsychological assessment were applied in 26 adolescent narcolepsy patients and 30 healthy controls. fMRI data were analyzed in three ways: group independent component analysis and a graph theoretical method were applied to evaluate topological properties within the whole brain. Lastly, network-based statistics was utilized for group comparisons in region-to-region connectivity. The relationship between topological properties and neuropsychiatric behaviors was analyzed with correlation analyses.
Results
In addition to sleepiness, depressive symptoms and impulsivity were detected in adolescent narcolepsy. In adolescent narcolepsy, functional connectivity was decreased between regions of the limbic system and the default mode network (DMN), and increased in the visual network. Adolescent narcolepsy patients exhibited disrupted small-world network properties. Regional alterations in the caudate nucleus (CAU) and posterior cingulate gyrus were associated with subjective sleepiness and regional alterations in the CAU and inferior occipital gyrus were associated with impulsiveness. Remodeling within the salience network and the DMN was associated with sleepiness, depressive feelings, and impulsive behaviors in narcolepsy.
Conclusions
Alterations in brain connectivity and regional topological properties in narcoleptic adolescents were associated with their sleepiness, depressive feelings, and impulsive behaviors.
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Affiliation(s)
- Xiao Fulong
- Department of General Internal Medicine, Peking University People’s Hospital, Beijing, People’s Republic of China
| | - Karen Spruyt
- Lyon Neuroscience Research Center, INSERM U1028-CNRS UMR 5292, School of Medicine, University Claude Bernard, Lyon, France
| | - Lu Chao
- Department of Radiology, Peking University International Hospital, Beijing, People’s Republic of China
| | - Zhao Dianjiang
- Department of Radiology, Peking University International Hospital, Beijing, People’s Republic of China
| | - Zhang Jun
- Department of Neurology, Peking University People’s Hospital, Beijing, People’s Republic of China
| | - Han Fang
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Peking University People’s Hospital, Beijing, People’s Republic of China
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Pizza F, Barateau L, Jaussent I, Vandi S, Antelmi E, Mignot E, Dauvilliers Y, Plazzi G. Validation of Multiple Sleep Latency Test for the diagnosis of pediatric narcolepsy type 1. Neurology 2019; 93:e1034-e1044. [PMID: 31405906 DOI: 10.1212/wnl.0000000000008094] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Accepted: 05/21/2019] [Indexed: 01/07/2023] Open
Abstract
ObjectiveTo validate polysomnographic markers (sleep latency and sleep-onset REM periods [SOREMPs] at the Multiple Sleep Latency Test [MSLT] and nocturnal polysomnography [PSG]) for pediatric narcolepsy type 1 (NT1) against CSF hypocretin-1 (hcrt-1) deficiency and presence of cataplexy, as no criteria are currently validated in children.MethodsClinical, neurophysiologic, and, when available, biological data (HLA-DQB1*06:02 positivity, CSF hcrt-1 levels) of 357 consecutive children below 18 years of age evaluated for suspected narcolepsy were collected. Best MSLT cutoffs were obtained by receiver operating characteristic (ROC) curve analysis by contrasting among patients with available CSF hcrt-1 assay (n = 228) with vs without CSF hcrt-1 deficiency, and further validated in patients without available CSF hcrt-1 against cataplexy (n = 129).ResultsPatients with CSF hcrt-1 deficiency were best recognized using a mean MSLT sleep latency ≤8.2 minutes (area under the ROC curve of 0.985), or by at least 2 SOREMPs at the MSLT (area under the ROC curve of 0.975), or the combined PSG + MSLT (area under the ROC curve of 0.977). Although specificity and sensitivity of reference MSLT sleep latency ≤8 minutes and ≥2 SOREMPs (nocturnal SOREMP included) was 100% and 94.87%, the combination of MSLT sleep latency and SOREMP counts did not improve diagnostic accuracy. Age or sex also did not significantly influence these results in our pediatric population.ConclusionsAt least 2 SOREMPs or a mean sleep latency ≤8.2 minutes at the MSLT are valid and reliable markers for pediatric NT1 diagnosis, a result contrasting with adult NT1 criteria.Classification of evidenceThis study provides Class III evidence that for children with suspected narcolepsy, polysomnographic and MSLT markers accurately identify those with narcolepsy type 1.
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Affiliation(s)
- Fabio Pizza
- From the Department of Biomedical and Neuromotor Sciences (DIBINEM) (F.P., S.V., E.A., G.P.), University of Bologna; IRCCS Istituto delle Scienze Neurologiche di Bologna (F.P., S.V., E.A., G.P.), Italy; National Reference Centre for Orphan Diseases, Narcolepsy, Rare Hypersomnias, Sleep Disorders Center, Department of Neurology (L.B., Y.D.), Gui de Chauliac Hospital, Montpellier; Inserm, U1061 (L.B., I.J., Y.D.), Montpellier; University of Montpellier (L.B., I.J., Y.D.), France; and Stanford University Center for Sleep Sciences, Department of Psychiatry and Behavioral Sciences (E.M.), Stanford University School of Medicine, Palo Alto, CA
| | - Lucie Barateau
- From the Department of Biomedical and Neuromotor Sciences (DIBINEM) (F.P., S.V., E.A., G.P.), University of Bologna; IRCCS Istituto delle Scienze Neurologiche di Bologna (F.P., S.V., E.A., G.P.), Italy; National Reference Centre for Orphan Diseases, Narcolepsy, Rare Hypersomnias, Sleep Disorders Center, Department of Neurology (L.B., Y.D.), Gui de Chauliac Hospital, Montpellier; Inserm, U1061 (L.B., I.J., Y.D.), Montpellier; University of Montpellier (L.B., I.J., Y.D.), France; and Stanford University Center for Sleep Sciences, Department of Psychiatry and Behavioral Sciences (E.M.), Stanford University School of Medicine, Palo Alto, CA
| | - Isabelle Jaussent
- From the Department of Biomedical and Neuromotor Sciences (DIBINEM) (F.P., S.V., E.A., G.P.), University of Bologna; IRCCS Istituto delle Scienze Neurologiche di Bologna (F.P., S.V., E.A., G.P.), Italy; National Reference Centre for Orphan Diseases, Narcolepsy, Rare Hypersomnias, Sleep Disorders Center, Department of Neurology (L.B., Y.D.), Gui de Chauliac Hospital, Montpellier; Inserm, U1061 (L.B., I.J., Y.D.), Montpellier; University of Montpellier (L.B., I.J., Y.D.), France; and Stanford University Center for Sleep Sciences, Department of Psychiatry and Behavioral Sciences (E.M.), Stanford University School of Medicine, Palo Alto, CA
| | - Stefano Vandi
- From the Department of Biomedical and Neuromotor Sciences (DIBINEM) (F.P., S.V., E.A., G.P.), University of Bologna; IRCCS Istituto delle Scienze Neurologiche di Bologna (F.P., S.V., E.A., G.P.), Italy; National Reference Centre for Orphan Diseases, Narcolepsy, Rare Hypersomnias, Sleep Disorders Center, Department of Neurology (L.B., Y.D.), Gui de Chauliac Hospital, Montpellier; Inserm, U1061 (L.B., I.J., Y.D.), Montpellier; University of Montpellier (L.B., I.J., Y.D.), France; and Stanford University Center for Sleep Sciences, Department of Psychiatry and Behavioral Sciences (E.M.), Stanford University School of Medicine, Palo Alto, CA
| | - Elena Antelmi
- From the Department of Biomedical and Neuromotor Sciences (DIBINEM) (F.P., S.V., E.A., G.P.), University of Bologna; IRCCS Istituto delle Scienze Neurologiche di Bologna (F.P., S.V., E.A., G.P.), Italy; National Reference Centre for Orphan Diseases, Narcolepsy, Rare Hypersomnias, Sleep Disorders Center, Department of Neurology (L.B., Y.D.), Gui de Chauliac Hospital, Montpellier; Inserm, U1061 (L.B., I.J., Y.D.), Montpellier; University of Montpellier (L.B., I.J., Y.D.), France; and Stanford University Center for Sleep Sciences, Department of Psychiatry and Behavioral Sciences (E.M.), Stanford University School of Medicine, Palo Alto, CA
| | - Emmanuel Mignot
- From the Department of Biomedical and Neuromotor Sciences (DIBINEM) (F.P., S.V., E.A., G.P.), University of Bologna; IRCCS Istituto delle Scienze Neurologiche di Bologna (F.P., S.V., E.A., G.P.), Italy; National Reference Centre for Orphan Diseases, Narcolepsy, Rare Hypersomnias, Sleep Disorders Center, Department of Neurology (L.B., Y.D.), Gui de Chauliac Hospital, Montpellier; Inserm, U1061 (L.B., I.J., Y.D.), Montpellier; University of Montpellier (L.B., I.J., Y.D.), France; and Stanford University Center for Sleep Sciences, Department of Psychiatry and Behavioral Sciences (E.M.), Stanford University School of Medicine, Palo Alto, CA
| | - Yves Dauvilliers
- From the Department of Biomedical and Neuromotor Sciences (DIBINEM) (F.P., S.V., E.A., G.P.), University of Bologna; IRCCS Istituto delle Scienze Neurologiche di Bologna (F.P., S.V., E.A., G.P.), Italy; National Reference Centre for Orphan Diseases, Narcolepsy, Rare Hypersomnias, Sleep Disorders Center, Department of Neurology (L.B., Y.D.), Gui de Chauliac Hospital, Montpellier; Inserm, U1061 (L.B., I.J., Y.D.), Montpellier; University of Montpellier (L.B., I.J., Y.D.), France; and Stanford University Center for Sleep Sciences, Department of Psychiatry and Behavioral Sciences (E.M.), Stanford University School of Medicine, Palo Alto, CA.
| | - Giuseppe Plazzi
- From the Department of Biomedical and Neuromotor Sciences (DIBINEM) (F.P., S.V., E.A., G.P.), University of Bologna; IRCCS Istituto delle Scienze Neurologiche di Bologna (F.P., S.V., E.A., G.P.), Italy; National Reference Centre for Orphan Diseases, Narcolepsy, Rare Hypersomnias, Sleep Disorders Center, Department of Neurology (L.B., Y.D.), Gui de Chauliac Hospital, Montpellier; Inserm, U1061 (L.B., I.J., Y.D.), Montpellier; University of Montpellier (L.B., I.J., Y.D.), France; and Stanford University Center for Sleep Sciences, Department of Psychiatry and Behavioral Sciences (E.M.), Stanford University School of Medicine, Palo Alto, CA.
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Drissi NM, Warntjes M, Wessén A, Szakacs A, Darin N, Hallböök T, Landtblom AM, Gauffin H, Engström M. Structural anomaly in the reticular formation in narcolepsy type 1, suggesting lower levels of neuromelanin. NEUROIMAGE-CLINICAL 2019; 23:101875. [PMID: 31174102 PMCID: PMC6551567 DOI: 10.1016/j.nicl.2019.101875] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 04/04/2019] [Accepted: 05/25/2019] [Indexed: 12/18/2022]
Abstract
The aim of this study was to investigate structural changes in the brain stem of adolescents with narcolepsy, a disorder characterized by excessive daytime sleepiness, fragmented night-time sleep, and cataplexy. For this purpose, we used quantitative magnetic resonance imaging to obtain R1 and R2 relaxation rates, proton density, and myelin maps in adolescents with narcolepsy (n = 14) and healthy controls (n = 14). We also acquired resting state functional magnetic resonance imaging (fMRI) for brainstem connectivity analysis. We found a significantly lower R2 in the rostral reticular formation near the superior cerebellar peduncle in narcolepsy patients, family wise error corrected p = .010. Narcolepsy patients had a mean R2 value of 1.17 s-1 whereas healthy controls had a mean R2 of 1.31 s-1, which was a large effect size with Cohen d = 4.14. We did not observe any significant differences in R1 relaxation, proton density, or myelin content. The sensitivity of R2 to metal ions in tissue and the transition metal ion chelating property of neuromelanin indicate that the R2 deviant area is one of the neuromelanin containing nuclei of the brain stem. The close proximity and its demonstrated involvement in sleep-maintenance, specifically through orexin projections from the hypothalamus regulating sleep stability, as well as the results from the connectivity analysis, suggest that the observed deviant area could be the locus coeruleus or other neuromelanin containing nuclei in the proximity of the superior cerebellar peduncle. Hypothetically, the R2 differences described in this paper could be due to lower levels of neuromelanin in this area of narcolepsy patients.
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Affiliation(s)
- Natasha Morales Drissi
- Department of Medical and Health Sciences (IMH), Linköping University, 581 83 Linköping, Sweden; Center for Medical Image Science and Visualization, Linköping University, 581 83 Linköping, Sweden
| | - Marcel Warntjes
- Department of Medical and Health Sciences (IMH), Linköping University, 581 83 Linköping, Sweden; Center for Medical Image Science and Visualization, Linköping University, 581 83 Linköping, Sweden
| | | | - Attila Szakacs
- Department of Pediatrics, Queen Silvia Children's Hospital, Institute of Clinical Sciences, The Sahlgrenska Academy at the University of Gothenburg, 416 50 Gothenburg, Sweden
| | - Niklas Darin
- Department of Pediatrics, Queen Silvia Children's Hospital, Institute of Clinical Sciences, The Sahlgrenska Academy at the University of Gothenburg, 416 50 Gothenburg, Sweden
| | - Tove Hallböök
- Department of Pediatrics, Queen Silvia Children's Hospital, Institute of Clinical Sciences, The Sahlgrenska Academy at the University of Gothenburg, 416 50 Gothenburg, Sweden
| | - Anne-Marie Landtblom
- Center for Medical Image Science and Visualization, Linköping University, 581 83 Linköping, Sweden; Department of Clinical and Experimental Medicine (IKE), Linköping University, 581 83 Linköping, Sweden; Department of Neuroscience, Uppsala University, 752 36 Uppsala, Sweden
| | - Helena Gauffin
- Department of Clinical and Experimental Medicine (IKE), Linköping University, 581 83 Linköping, Sweden
| | - Maria Engström
- Department of Medical and Health Sciences (IMH), Linköping University, 581 83 Linköping, Sweden; Center for Medical Image Science and Visualization, Linköping University, 581 83 Linköping, Sweden.
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Huang B, Xu T, Wang Z, Chen K, Zhang J, Zhao Z, Zhuang J, Wu H. The clinical characteristics of cataplectic attack in narcolepsy type 1. Sleep Med 2019; 77:261-269. [PMID: 31607435 DOI: 10.1016/j.sleep.2019.03.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 03/19/2019] [Accepted: 03/20/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Cataplexy is a pathognomonic symptom of narcolepsy type 1. This study was conducted to clarify the clinical characteristics of cataplexy by staging, and to further analyse the correlations of clinical features and cataplectic stages in patients with narcolepsy type 1 (NT1). METHODS We experimentally triggered patients with NT1 into cataplexy while under video-polysomnography (v-PSG) monitoring in the sleep lab. The most serious cataplectic attack from each patient was analysed. Each cataplectic episode was segmented into four stages according to the v-PSG. Correlations were analysed between cataplectic stages in pairs, and between cataplectic stages and other clinical features. RESULTS We observed 81 cataplectic episodes in 21 patients with diverse triggers, including humorous or exciting videos, tickling, recalling horrible memories and exercising. Nine patients (43%) went through complete cataplectic attacks while the others experienced partial attacks. Four cataplectic stages (ie, triggering, resisting, atonic, and recovering) were identified according to clinical and electromyograms characteristics. Resisting stage is predominant (56.4%) in cataplexy, while atonic stage is most related with the total duration of cataplexy. The Epworth Sleepiness Scale score (ESS) has a positive correlation with the total duration of cataplexy. Both duration of cataplexy and ESS score are negatively correlated with disease course. However, medication history seems have no influence on either cataplexy duration or ESS score. CONCLUSION Four-stage segmentation shows the dynamic process of the cataplectic attack, which is different from the traditional classification of complete or partial cataplexy. Resisting stage is necessary for every cataplexy and might reflect the compensation mechanism, while atonic stage may be omitted in some patients. The severity of narcolepsy reduces with the extension of natural course regardless of medication history.
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Affiliation(s)
- Bei Huang
- Department of Neurology, Changzheng Hospital, The Second Medical University of Chinese PLA, Shanghai, China; Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region of China
| | - Tao Xu
- Department of Neurology, Changzheng Hospital, The Second Medical University of Chinese PLA, Shanghai, China
| | - Zongwen Wang
- Department of Neurology, Changzheng Hospital, The Second Medical University of Chinese PLA, Shanghai, China
| | - Kun Chen
- Department of Neurology, Changzheng Hospital, The Second Medical University of Chinese PLA, Shanghai, China
| | - Jihui Zhang
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region of China
| | - Zhongxin Zhao
- Department of Neurology, Changzheng Hospital, The Second Medical University of Chinese PLA, Shanghai, China
| | - Jianhua Zhuang
- Department of Neurology, Changzheng Hospital, The Second Medical University of Chinese PLA, Shanghai, China.
| | - Huijuan Wu
- Department of Neurology, Changzheng Hospital, The Second Medical University of Chinese PLA, Shanghai, China.
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Reducing the Clinical and Socioeconomic Burden of Narcolepsy by Earlier Diagnosis and Effective Treatment. Sleep Med Clin 2017; 12:61-71. [PMID: 28159098 DOI: 10.1016/j.jsmc.2016.10.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Rocca FL, Finotti E, Pizza F, Ingravallo F, Gatta M, Bruni O, Plazzi G. Psychosocial Profile and Quality of Life in Children With Type 1 Narcolepsy: A Case-Control Study. Sleep 2016; 39:1389-98. [PMID: 27166243 DOI: 10.5665/sleep.5970] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 03/25/2016] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVES To investigate behavioral aspects and quality of life in children and adolescents with type 1 narcolepsy (NT1). METHODS We performed a case-control study comparing 29 patients with NT1 versus sex- and age-matched patients with idiopathic epilepsy (n = 39) and healthy controls (n = 39). Behavior and quality of life were evaluated by self-administered questionnaires (Child Behavior Checklist, Pediatric Quality of Life Inventory). Patient groups were contrasted and scale results were correlated with clinical and polysomnographic parameters, and cerebrospinal fluid hypocretin-1 levels. RESULTS Young patients with NT1 showed increased internalizing problems associated with aggressive behavior. Emotional profile in patients with NT1 positively correlated with age at onset, diagnostic delay, and subjective sleepiness, whereas treatment and disease duration were associated with fewer behavioral problems (attention problems, aggressive behavior, and attention deficit/hyperactivity disorder). Psychosocial health domains of pediatric NT1 were worse than in healthy controls, whereas the physical health domains were comparable. CONCLUSIONS Young NT1 patients show a discrete pattern of altered behavioral, thought, and mood profile in comparison with healthy controls and with idiopathic epilepsy patients thus suggesting a direct link with sleepiness. Further studies investigating behavior in patients with idiopathic hypersomnia or type 2 narcolepsy are needed to disentangle the role of REM sleep dysfunction and hypocretin deficiency in psychiatric disorders. Symptoms of withdrawal, depression, somatic complaints, thought problems, and aggressiveness were common, NT1 children perceived lower school competencies than healthy children, and their parents also reported worse psychosocial health. Our data suggest that early effective treatment and disease self-awareness should be promoted in NT1 children for their positive effect on behavior and psychosocial health.
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Affiliation(s)
| | - Elena Finotti
- Department of Rehabilitation, Child and Adolescent Neuropsychiatry Unit, ULSS 6 Vicenza, Italy
| | - Fabio Pizza
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy.,IRCCS Institute of Neurological Sciences, ASL di Bologna, Bologna, Italy
| | - Francesca Ingravallo
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Michela Gatta
- Department of Woman and Child Health, University of Padua, Italy
| | - Oliviero Bruni
- Department of Developmental Neurology and Psychiatry, Centre for Pediatric Sleep Disorders, Sapienza University, Rome, Italy
| | - Giuseppe Plazzi
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy.,IRCCS Institute of Neurological Sciences, ASL di Bologna, Bologna, Italy
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Rives-Lange C, Karsenty A, Chantereau H, Oderda L, Dubern B, Lecendreux M, Tounian P. [Narcolepsy in sleepy obese children. Two case reports]. Arch Pediatr 2016; 23:603-6. [PMID: 27133373 DOI: 10.1016/j.arcped.2016.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 10/26/2015] [Accepted: 03/11/2016] [Indexed: 11/17/2022]
Abstract
Narcolepsy is a disabling disorder, characterized by excessive daytime sleepiness, irresistible sleep attacks, and partial or complete cataplexy. Many cases of obesity and precocious puberty have been reported in narcoleptic children, suggesting that the deficiency of hypocretin in narcolepsy could also be implicated in appetite stimulation. We report the observations of two young girls, who were referred for obesity and who developed narcolepsy accompanied by an abrupt weight gain. In both cases, specific drugs promoted wakefulness and overweight stabilization. Narcolepsy has to be suspected in sleepy obese children and not misdiagnosed as obstructive apnea. A nocturnal polysomnography with multiple sleep latency tests should be performed to confirm the diagnosis and begin specific treatment that is effective for sleep disorders and weight gain.
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Affiliation(s)
- C Rives-Lange
- Service de nutrition et gastro-entérologie pédiatriques, hôpital Trousseau, AP-HP, université Paris 6, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France
| | - A Karsenty
- Service de nutrition et gastro-entérologie pédiatriques, hôpital Trousseau, AP-HP, université Paris 6, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France.
| | - H Chantereau
- Service de nutrition et gastro-entérologie pédiatriques, hôpital Trousseau, AP-HP, université Paris 6, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France
| | - L Oderda
- Service de nutrition et gastro-entérologie pédiatriques, hôpital Trousseau, AP-HP, université Paris 6, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France
| | - B Dubern
- Service de nutrition et gastro-entérologie pédiatriques, hôpital Trousseau, AP-HP, université Paris 6, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France
| | - M Lecendreux
- Centre pédiatrique des pathologies du sommeil, CHU Robert-Debré, AP-HP, 48, boulevard Serrurier, 75019 Paris, France; CNR narcolepsie-hypersomnie, 75019 Paris, France
| | - P Tounian
- Service de nutrition et gastro-entérologie pédiatriques, hôpital Trousseau, AP-HP, université Paris 6, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France
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Abstract
Sleepiness is not uncommon in the pediatric population. Although the etiology can be multifactorial, sleepiness due to increased sleep drive, also called central hypersomnia, is a common cause. The third edition of the International Classification of Sleep Disorders updated the diagnostic criteria for several of the central disorders of hypersomnolence, most notably narcolepsy. Although the International Classification Of Sleep Disorders-3 is not specific to pediatric patients, the peak incidence for many of the included disorders occurs during childhood or adolescence. As a result, recognition of these lifelong and potentially debilitating disorders is imperative for providers who evaluate pediatric patients. This review provides an update on recent advances in the field and highlights some of the diagnostic dilemmas, unique clinical features, and variable presentations associated with central disorders of hypersomnolence within the pediatric population.
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Affiliation(s)
- Thomas J Dye
- Division of Neurology, Cincinnati Children׳s Hospital Medical Center, Cincinnati, OH.
| | - Sejal V Jain
- Division of Neurology, Cincinnati Children׳s Hospital Medical Center, Cincinnati, OH
| | - Sanjeev V Kothare
- Department of Neurology, NYU Langone Medical Center, New York, NY; Pediatric Sleep Program, Comprehensive Epilepsy & Sleep Center, NYU Langone Medical Center, New York, NY
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Narcolepsia-cataplejía, una enfermedad de etiología autoinmune. An Pediatr (Barc) 2015; 82:271-2. [DOI: 10.1016/j.anpedi.2014.10.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 09/24/2014] [Accepted: 10/24/2014] [Indexed: 11/21/2022] Open
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Navarro-Abia V, Pedrera-Mazarro A, Bélanger-Quintana A, Aparicio-Meix J. Narcolepsy-cataplexy, a disease of autoimmune origin. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2015. [DOI: 10.1016/j.anpede.2015.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Gamma-Hydroxybutyrate (Sodium Oxybate): From the Initial Synthesis to the Treatment of Narcolepsy–Cataplexy and Beyond. Sleep Med 2015. [DOI: 10.1007/978-1-4939-2089-1_63] [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: 11/26/2022]
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Abstract
Narcolepsy is a neurological disorder frequently occurring from childhood and persisting through adolescence and adulthood. Individuals suffering from narcolepsy exhibit excessive daytime somnolence, sleep attacks, cataplexy, dysomnia, metabolic perturbations including weight gain, and problems in social interaction and academic performance. The prevalence of narcolepsy in childhood is not known but can be estimated from adult studies to be greater than 20-60 per 100,000 in Western countries. The 2009 (A) H1N1 vaccination campaign led to an increase of narcoleptic cases both in children and in adults, supporting the autoimmune hypothesis of the disease. This article focuses on the epidemiology, etiology, and particularities of treatment in pediatric narcolepsy and details the effects of the drugs used to treat this condition, including recent trends in the field. Future therapeutic directions are also discussed. At present, medications used to treat children or adolescents have shown efficacy mostly based on clinical experience, given the lack of level 1 evidence-based studies in the pediatric population. Therefore, most compounds used in adult narcolepsy to target clinical symptoms such as wake-promoting or anticataplectic agents are prescribed off-label in pediatric patients. Published research shows the benefit of drug therapy for narcoleptic children, but these must be dispensed with caution in the absence of well conducted clinical trials.
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Affiliation(s)
- Michel Lecendreux
- Pediatric Sleep Center and National Reference Center for Orphan Diseases, Narcolepsy, Idiopathic Hypersomnia and Kleine-Levin Syndrome, Robert Debre University Hospital, 48 Boulevard Serurier, 75019, Paris, France,
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Inocente CO, Gustin MP, Lavault S, Guignard-Perret A, Raoux A, Christol N, Gerard D, Dauvilliers Y, Reimão R, Bat-Pitault F, Lin JS, Arnulf I, Lecendreux M, Franco P. Quality of life in children with narcolepsy. CNS Neurosci Ther 2014; 20:763-71. [PMID: 24922610 DOI: 10.1111/cns.12291] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 04/26/2014] [Accepted: 04/30/2014] [Indexed: 12/01/2022] Open
Abstract
AIMS To evaluate the health-related quality of life (HRQL) and its correlates in children and adolescents with narcolepsy. METHODS We compared the clinical characteristics of control subjects and patients with primary narcolepsy from data collected at the National Reference Centers for Narcolepsy. RESULTS The cohort included 69 control subjects (29 boys) and 117 patients (65 boys; 59 de novo patients). Cataplexy was present in 81% and DQB1*0602 was positive in 91%. The control children were older (13.5±3.2 vs. 11.6±3.1 years, P<0.001) and less obese (1.4% vs. 60%, P<0.001). Twenty-five percent of the patients and 15.6% of the control subjects had clinically significant depressive feelings on Children's Depression Inventory (CDI≥16) (NS). Fifty-three narcoleptic and 43 control adolescents, 31 narcoleptic children and 23 control children filled out the HRQL questionnaires as well as 83 parents of patients and 60 parents of control subjects. Narcolepsy seriously impacts HRQL in terms of vitality, physical well-being, relations with friends and leisure activities, especially in adolescents. Depression was the factor that most affected HRQL in both narcoleptic and control subjects. For the control subjects and the narcoleptic patients, when the CDI score was entered into the multivariable regression model adjusted for gender and age, no other continuous independent variable could significantly increase the likelihood of the model. When the CDI score increased by 1, the mean HRQL score decreased by 1.7 for narcoleptic patients and 1.5 for control subjects. Apnea-hypopnoea index, diagnosis delay, disease duration, obesity, the presence of cataplexy or treatment had no effects on HRQL. CONCLUSIONS Narcoleptic children and adolescents were at high risk for poor HRQL. Depressive symptoms had a major impact on HRQL. We recommend a more thorough assessment and management of psychological health in this population.
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Affiliation(s)
- Clara O Inocente
- Integrative Physiology of Brain Arousal System, CRNL, INSERM-U1028, CNRS UMR5292, University Lyon1, Lyon, France
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Prasad M, Setty G, Ponnusamy A, Hussain N, Desurkar A. Cataplectic facies: clinical marker in the diagnosis of childhood narcolepsy-report of two cases. Pediatr Neurol 2014; 50:515-7. [PMID: 24656461 DOI: 10.1016/j.pediatrneurol.2014.01.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Revised: 12/27/2013] [Accepted: 01/01/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Narcolepsy is a chronic disease and is commonly diagnosed in adulthood. However, more than half of the patients have onset of symptoms in childhood and/or adolescence. The full spectrum of clinical manifestations, namely excessive daytime sleepiness, cataplexy, hypnagogic hallucinations, and sleep paralysis, is usually not present at disease onset, delaying diagnosis during childhood. Mean delay in diagnosis since symptom onset is known to be several years. Initial manifestations can sometimes be as subtle as only partial drooping of eyelids leading to confusion with a myasthenic condition. PATIENTS We present two children who presented with "cataplectic facies," an unusual facial feature only recently described in children with narcolepsy with cataplexy. RESULT The diagnosis of narcolepsy was confirmed by multiple sleep latency test along with human leukocyte antigen typing and cerebrospinal fluid hypocretin assay. CONCLUSION The diagnosis of narcolepsy with cataplexy at onset can be challenging in young children. With more awareness of subtle signs such as cataplectic facies, earlier diagnosis is possible. To date, only 11 children between 6 and 18 years of age presenting with typical cataplectic facies have been reported in the literature. We present two patients, one of whom is the youngest individual (4 years old) yet described with the typical cataplectic facies.
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Affiliation(s)
- Manish Prasad
- Department of Paediatrics, Pinderfield General Hospital, Wakefield, UK.
| | - Gururaj Setty
- Department of Paediatrics, Horton General Hospital, Banbury, UK
| | - Athi Ponnusamy
- Department of Clinical Neurophysiology, Sheffield Children's Hospital, Sheffield, UK
| | - Nahin Hussain
- Department of Paediatric Neurology, Leicester Royal Infirmary, Leicester, UK
| | - Archana Desurkar
- Department of Paediatric Neurology, Sheffield Children's Hospital, Sheffield, UK
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Dias Costa F, Barreto MI, Clemente V, Vasconcelos M, Estêvão MH, Madureira N. Narcolepsy in pediatric age - Experience of a tertiary pediatric hospital. ACTA ACUST UNITED AC 2014; 7:53-8. [PMID: 26483902 PMCID: PMC4521650 DOI: 10.1016/j.slsci.2014.07.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2013] [Accepted: 01/21/2014] [Indexed: 12/01/2022]
Abstract
Narcolepsy, a chronic disorder of the sleep–wake cycle of multifactorial etiology, is characterized by excessive daytime sleepiness, often associated with cataplexy, hypnagogic/hypnopompic hallucinations and sleep paralysis. Both early clinical suspicion and therapeutic approach are essential for promotion of cognitive development and social integration of these children. The authors present a descriptive retrospective study of a series of eight children in whom symptoms first started between 6.8 and 10.5 years of age. Diagnostic delay ranged from 4 months to 2 years. One child had H1N1 flu vaccination eight months before the clinical onset. The first multiple sleep latency test was positive in 6 of 8 cases. All cases were treated with methylphenidate, and venlafaxine was associated in 4 of them. In one case the initial therapy was exclusively behavioral. In all cases, symptomatic improvement, better school performance and social integration were achieved after therapeutic adjustment.
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Affiliation(s)
- Filipa Dias Costa
- Pediatric Hospital, Hospital and University Center of Coimbra, Portugal
| | | | - Vanda Clemente
- Laboratory of Sleep and Ventilation, Pediatric Hospital, Hospital and University Center of Coimbra, Portugal
| | - Mónica Vasconcelos
- Center of Child Development, Pediatric Hospital, Hospital and University Center of Coimbra, Portugal
| | - Maria Helena Estêvão
- Laboratory of Sleep and Ventilation, Pediatric Hospital, Hospital and University Center of Coimbra, Portugal
| | - Núria Madureira
- Laboratory of Sleep and Ventilation, Pediatric Hospital, Hospital and University Center of Coimbra, Portugal
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Depressive feelings in children with narcolepsy. Sleep Med 2014; 15:309-14. [PMID: 24503472 DOI: 10.1016/j.sleep.2013.08.798] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Revised: 07/28/2013] [Accepted: 08/04/2013] [Indexed: 12/27/2022]
Abstract
OBJECTIVES We aimed to evaluate depressive feelings and their correlations in children and adolescents with narcolepsy collected in national reference centers for narcolepsy. METHODS We compared clinical and sleep characteristics of patients with and without depressive symptoms evaluated on the Children's Depression Inventory (CDI). RESULTS Our study sample included 88 children (44 boys; 44 de novo patients) with a mean age of 11.9 ± 3.1 years at diagnosis (37.5% were aged ⩽ 10 years). Obesity was found in 59% of the sample and cataplexy was present in 80.7%. The DQB1*0602 allele was positive in 93.5% of our sample. There were 25% of children who had clinically depressive feelings (CDI>16), especially girls older than the age of 10 years. Bivariate associations indicated that depressive feelings were associated with fatigue (48%), hyperactivity (31%), insomnia (16%), and excessive daytime sleepiness (EDS) (14-24%). In the multivariate model adjusted for gender and age, only fatigue explained the variability of the depression score. CONCLUSION In our large cohort, high levels of depressive symptoms essentially expressed by fatigue affected 25% of children with narcolepsy. The girls older than 10 years of age were especially vulnerable. The similar prevalence of depressive feelings in treated vs never-treated patients suggests a specific need for diagnosing and managing this symptom in young patients with narcolepsy.
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Katzav A, Arango MT, Kivity S, Tanaka S, Givaty G, Agmon-Levin N, Honda M, Anaya JM, Chapman J, Shoenfeld Y. Passive transfer of narcolepsy: Anti-TRIB2 autoantibody positive patient IgG causes hypothalamic orexin neuron loss and sleep attacks in mice. J Autoimmun 2013; 45:24-30. [DOI: 10.1016/j.jaut.2013.06.010] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Accepted: 06/18/2013] [Indexed: 01/07/2023]
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Inocente CO, Lavault S, Lecendreux M, Dauvilliers Y, Reimao R, Gustin MP, Castets S, Spiegel K, Lin JS, Arnulf I, Franco P. Impact of obesity in children with narcolepsy. CNS Neurosci Ther 2013; 19:521-8. [PMID: 23574649 DOI: 10.1111/cns.12105] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Revised: 02/25/2013] [Accepted: 02/26/2013] [Indexed: 12/20/2022] Open
Abstract
AIMS To evaluate the impact of obesity on clinical and sleep characteristics in a population of narcoleptic children. METHODS Data from the children diagnosed with idiopathic narcolepsy in the National Reference Centers for Narcolepsy were collected between 2008 and 2011. Clinical and electrophysiological characteristics were compared between obese (body mass index [BMI] greater than P97) and nonobese children. RESULTS The 117 children (65 boys, 59 de novo patients) had a mean age of 11.6 ± 3.1 years on diagnosis. Cataplexy was present in 81%, DQB1*0602 in 91%. Mean BMI was 23.2 ± 5.2 kg/m(2) and BMI z-score was 2.9 ± 2.6. Obesity was found in 60% with a similar prevalence in treated versus de novo patients and in patients with and without cataplexy. Sleepiness and cataplexy started earlier in obese children. Obese narcoleptic children had lower sleep efficiency, higher apnea hypopnea index and respiratory arousals index (RAI) than nonobese children. BMI z-score was positively correlated with RAI. Obese children were more tired and missed more often school than nonobese children. CONCLUSION Obesity affects more than 50% of narcoleptic children, mostly younger at disease onset, and has a deleterious impact on sleep quality as well as on school attendance.
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Affiliation(s)
- Clara Odilia Inocente
- Integrative Physiology of Brain Arousal System, CRNL, University Lyon 1, Lyon, France
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Partinen M. Disconjugated binocular eye movements at onset of multiple sleep latency test in childhood narcolepsy. Sleep Biol Rhythms 2013. [DOI: 10.1111/j.1479-8425.2012.00543.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Poli F, Pizza F, Mignot E, Ferri R, Pagotto U, Taheri S, Finotti E, Bernardi F, Pirazzoli P, Cicognani A, Balsamo A, Nobili L, Bruni O, Plazzi G. High prevalence of precocious puberty and obesity in childhood narcolepsy with cataplexy. Sleep 2013; 36:175-81. [PMID: 23372264 DOI: 10.5665/sleep.2366] [Citation(s) in RCA: 94] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
STUDY OBJECTIVES We analyzed the potential predictive factors for precocious puberty, observed in some cases of childhood narcolepsy with cataplexy (NC) and for obesity, a much more common feature of NC, through a systematic assessment of pubertal staging, body mass index (BMI), and metabolic/endocrine biochemical analyses. DESIGN Cross-sectional on consecutive recruitment. SETTING Hospital sleep center and pediatric unit. PATIENTS Forty-three children and adolescents with NC versus 52 age-matched obese children as controls. INTERVENTIONS N/A. MEASUREMENTS AND RESULTS Patients underwent clinical interview, polysomnographic recordings, cerebrospinal fluid hypocretin-1 measurement, and human leukocyte antigen typing. Height, weight, arterial blood pressure, and Tanner pubertal stage were evaluated. Plasma lipid and glucose profiles were analyzed. When an altered pubertal development was clinically suspected, plasma concentrations of hypothalamic-pituitary-gonadal axis hormones were determined. Children with NC showed a high prevalence of overweight/obesity (74%) and a higher occurrence of precocious puberty (17%) than obese controls (1.9%). Isolated signs of accelerated pubertal development (thelarche, pubic hair, advanced bone age) were also present (41%). Precocious puberty was significantly predicted by a younger age at first NC symptom onset but not by overweight/obesity or other factors. In addition, overweight/obesity was predicted by younger age at diagnosis; additional predictors were found for overweight/obesity (short disease duration, younger age at weight gain and lower high-density lipoprotein cholesterol), which did not include precocious puberty. NC symptoms, pubertal signs appearance, and body weight gain developed in close temporal sequence. CONCLUSIONS NC occurring during prepubertal age is frequently accompanied by precocious puberty and overweight/obesity, suggesting an extended hypothalamic dysfunction. The severity of these comorbidities and the potential related risks require a multidiagnostic approach and a tailored therapeutic management.
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Affiliation(s)
- Francesca Poli
- Department of Neurological Sciences, University of Bologna - IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
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Poli F, Overeem S, Lammers GJ, Plazzi G, Lecendreux M, Bassetti CL, Dauvilliers Y, Keene D, Khatami R, Li Y, Mayer G, Nohynek H, Pahud B, Paiva T, Partinen M, Scammell TE, Shimabukuro T, Sturkenboom M, van Dinther K, Wiznitzer M, Bonhoeffer J. Narcolepsy as an adverse event following immunization: Case definition and guidelines for data collection, analysis and presentation. Vaccine 2013; 31:994-1007. [PMID: 23246545 DOI: 10.1016/j.vaccine.2012.12.014] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Accepted: 12/05/2012] [Indexed: 01/11/2023]
Affiliation(s)
- Francesca Poli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
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Abstract
Narcolepsy and other syndromes associated with excessive daytime sleepiness can be challenging to treat. New classifications now distinguish narcolepsy/hypocretin deficiency (also called type 1 narcolepsy), a lifelong disorder with well-established diagnostic procedures and etiology, from other syndromes with hypersomnolence of unknown causes. Klein-Levin Syndrome, a periodic hypersomnia associated with cognitive and behavioral abnormalities, is also considered a separate entity with separate therapeutic protocols. Non hypocretin-related hypersomnia syndromes are diagnoses of exclusion. These diagnoses are only made after eliminating sleep deprivation, sleep apnea, disturbed nocturnal sleep, and psychiatric comorbidities as the primary cause of daytime sleepiness. The treatment of narcolepsy/hypocretin deficiency is well-codified, and involves pharmacotherapies using sodium oxybate, stimulants, and/or antidepressants, plus behavioral modifications. These therapies are almost always needed, and the risk-to-benefit ratio is clear, notably in children. Detailed knowledge of the pharmacological profile of each compound is needed to optimize use. Treatment for other syndromes with hypersomnolence is more challenging and less codified. Preferably, therapy should be conservative (such as modafinil, atomoxetine, behavioral modifications), but it may have to be more aggressive (high-dose stimulants, sodium oxybate, etc.) on a case-by-case, empirical trial basis. As cause and evolution are unknown in these conditions, it is important to challenge diagnosis and therapy over time, keeping in mind the possibility of tolerance and the development of stimulant addiction. Kleine-Levin Syndrome is usually best left untreated, although lithium can be considered in severe cases with frequent episodes. Guidelines are provided based on the literature and personal experience of the author.
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Affiliation(s)
- Emmanuel J M Mignot
- Stanford Center for Sleep Sciences and Medicine, Stanford University Medical School, Palo Alto, CA 94304, USA.
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31
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Lecendreux M, Bruni O, Franco P, Gringras P, Konofal E, Nevsimalova S, Paiva T, Partinen M, Peeters E, Peraita-Adrados R, Plazzi G, Poli F. Clinical experience suggests that modafinil is an effective and safe treatment for paediatric narcolepsy. J Sleep Res 2012; 21:481-3. [DOI: 10.1111/j.1365-2869.2011.00991.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Affiliation(s)
- Erick N Viorritto
- Department of Neurology, Children's National Medical Center, 111 Michigan Avenue NW, Washington, DC 20010, USA.
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Plazzi G, Pizza F, Palaia V, Franceschini C, Poli F, Moghadam KK, Cortelli P, Nobili L, Bruni O, Dauvilliers Y, Lin L, Edwards MJ, Mignot E, Bhatia KP. Complex movement disorders at disease onset in childhood narcolepsy with cataplexy. ACTA ACUST UNITED AC 2011; 134:3477-89. [PMID: 21930661 PMCID: PMC3235554 DOI: 10.1093/brain/awr244] [Citation(s) in RCA: 115] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Narcolepsy with cataplexy is characterized by daytime sleepiness, cataplexy (sudden loss of bilateral muscle tone triggered by emotions), sleep paralysis, hypnagogic hallucinations and disturbed nocturnal sleep. Narcolepsy with cataplexy is most often associated with human leucocyte antigen-DQB1*0602 and is caused by the loss of hypocretin-producing neurons in the hypothalamus of likely autoimmune aetiology. Noting that children with narcolepsy often display complex abnormal motor behaviours close to disease onset that do not meet the classical definition of cataplexy, we systematically analysed motor features in 39 children with narcolepsy with cataplexy in comparison with 25 age- and sex-matched healthy controls. We found that patients with narcolepsy with cataplexy displayed a complex array of ‘negative’ (hypotonia) and ‘active’ (ranging from perioral movements to dyskinetic–dystonic movements or stereotypies) motor disturbances. ‘Active’ and ‘negative’ motor scores correlated positively with the presence of hypotonic features at neurological examination and negatively with disease duration, whereas ‘negative’ motor scores also correlated negatively with age at disease onset. These observations suggest that paediatric narcolepsy with cataplexy often co-occurs with a complex movement disorder at disease onset, a phenomenon that may vanish later in the course of the disease. Further studies are warranted to assess clinical course and whether the associated movement disorder is also caused by hypocretin deficiency or by additional neurochemical abnormalities.
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Affiliation(s)
- Giuseppe Plazzi
- Department of Neurological Sciences, University of Bologna, 40123 Bologna, Italy.
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Han F, Lin L, Li J, Aran A, Dong SX, An P, Zhao L, Li M, Li QY, Yan H, Wang JS, Gao HY, Li M, Gao ZC, Strohl KP, Mignot E. Presentations of primary hypersomnia in Chinese children. Sleep 2011; 34:627-32. [PMID: 21532956 DOI: 10.1093/sleep/34.5.627] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE To retrospectively describe childhood presentations of primary hypersomnia with an emphasis on narcolepsy-cataplexy in a Chinese population. METHODS A total of 417 children (< 18 years old) successively presenting with complaints of hypersomnia without anatomic cause or sleep apnea risk were evaluated using the Stanford Sleep Inventory, human leukocyte antigen (HLA) DQB1*0602 typing, and MSLT recordings. CSF hypocretin-1 was measured in 47 cases to document hypocretin deficiency. A subgroup ("narcolepsy/hypocretin deficiency") with likely hypocretin deficiency (low hypocretin-1 or HLA positive with clear-cut cataplexy) was further examined for presentations prior to, around, or after puberty. RESULTS Narcolepsy with (n = 361) or without (n = 17) cataplexy presented at an earlier age and with increased male predominance when compared to idiopathic hypersomnia (n = 39, P < 0.01). Nearly 70% of those with narcolepsy/hypocretin deficiency (n = 271) had disease onset before age 10 y, and 15% had onset before age 6, an unusually young age distribution. Onset was prior to puberty in 78% of cases. Clinical features were similar in presentations across puberty groups except for sleep paralysis, which increased in frequency with age/puberty. Mean sleep latency (MSL) decreased and the number of sleep onset REM periods (SOREMPs) increased with age/puberty, but MSLT diagnosis criteria (MSL ≤ 8 min, ≥ 2 SOREMPs) were similarly positive across groups. Familial clustering was present in only 1.7% of probands. CONCLUSION In children presenting with a complaint of primary hypersomnia to a sleep clinic in China, 86% (361/417) meet criteria for narcolepsy with cataplexy. Puberty did not affect positivity on the MSLT as a diagnostic feature. Sleep paralysis was the only symptom that increased with increasing age. In addition, narcolepsy with cataplexy in our clinic population appeared to begin at a younger age than usually reported in other studies.
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Affiliation(s)
- Fang Han
- Department of Pulmonary Medicine, Beijing University People’s Hospital, Beijing, China.
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