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Gool JK, Dang-Vu TT, van der Werf YD. White matter integrity in narcolepsy: the structural blueprint for functional complaints? Sleep 2024; 47:zsae020. [PMID: 38263318 PMCID: PMC11168760 DOI: 10.1093/sleep/zsae020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Indexed: 01/25/2024] Open
Affiliation(s)
- Jari K Gool
- Anatomy and Neurosciences, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Stichting Epilepsie Instellingen Nederland (SEIN), Sleep-Wake Centre, Heemstede, Netherlands
- Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands
- Compulsivity, Impulsivity and Attention, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Thien Thanh Dang-Vu
- Centre de recherche de l’Institut universitaire de gériatrie de Montréal, Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l’Ile-de-Montréal, Montreal, QC, Canada
- Center for Studies in Behavioral Neurobiology, Department of Health, Kinesiology and Applied Physiology, Concordia University, Montreal, QC, Canada
| | - Ysbrand D van der Werf
- Anatomy and Neurosciences, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Compulsivity, Impulsivity and Attention, Amsterdam Neuroscience, Amsterdam, The Netherlands
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2
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Hovi M, Roine U, Autti T, Heiskala H, Roine T, Kirjavainen T. Microstructural White Matter Abnormalities in Children and Adolescents With Narcolepsy Type 1. Pediatr Neurol 2024; 153:56-64. [PMID: 38320459 DOI: 10.1016/j.pediatrneurol.2024.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 01/06/2024] [Accepted: 01/08/2024] [Indexed: 02/08/2024]
Abstract
BACKGROUND In 2010, the H1N1 Pandemrix vaccination campaign was followed by a sudden increase in narcolepsy type 1 (NT1). We investigated the brain white matter microstructure in children with onset of NT1 within two years after the Pandemrix vaccination. METHODS We performed diffusion-weighted magnetic resonance imaging (MRI) on 19 children and adolescents with NT1 and 19 healthy controls. Imaging was performed at a median of 4 years after the diagnosis at a median age of 16 years. For the MRI, we used whole-brain tractography and tract-based spatial statistics (TBSS). We compared these results with medical records and questionnaire data. RESULTS Narcoleptic children showed a global decrease in mean, axial, and radial diffusivity and an increase in planarity coefficient in the white matter TBSS skeleton and tractography. These differences were widespread, and there was an increased asymmetry of the mean diffusivity in children with NT1. The global microstructural metrics were reflected in behavior, and especially the axial diffusion levels correlated with anxiety and depression symptoms and social and behavioral problems. CONCLUSIONS In pediatric patients with Pandemrix-associated NT1, several global changes in the brain white matter network skeleton were observed within five years after the onset of NT1. The degree of changes correlates with behavioral problems.
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Affiliation(s)
- Marita Hovi
- Children's Hospital, and Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Department of Pediatric Neurology, Children's Hospital, University of Helsinki and Helsinki, University Hospital, Helsinki, Finland
| | - Ulrika Roine
- Department of Pediatric Neurology, Children's Hospital, University of Helsinki and Helsinki, University Hospital, Helsinki, Finland; HUS Medical Imaging Center, Radiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Taina Autti
- HUS Medical Imaging Center, Radiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Hannu Heiskala
- Department of Pediatric Neurology, Children's Hospital, University of Helsinki and Helsinki, University Hospital, Helsinki, Finland
| | - Timo Roine
- HUS Medical Imaging Center, Radiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Espoo, Finland; Turku Brain and Mind Center, University of Turku, Turku, Finland
| | - Turkka Kirjavainen
- Children's Hospital, and Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
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3
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Morse AM, Naik S. Idiopathic Hypersomnia: Neurobiology, Diagnosis, and Management. CNS Drugs 2023; 37:305-322. [PMID: 37069414 DOI: 10.1007/s40263-023-00998-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/06/2023] [Indexed: 04/19/2023]
Abstract
Idiopathic hypersomnia is a chronic neurologic sleep disorder that manifests as excessive daytime sleepiness despite normal or prolonged sleep times for age. Frequently, idiopathic hypersomnia is clinically characterized by marked sleep inertia, long and unrefreshing naps, and a high sleep efficiency. Since the initial description, there has been an ongoing evolution of its nomenclature, approach to diagnosis, characterization of symptoms, and determination of the burden of disease. In addition, an increased attention to and study of its epidemiology, neurobiology, and potential therapeutic strategies has begun to contribute to a better approach to identifying and treating it. At present, idiopathic hypersomnia is considered an orphan disease with unknown frequency and the cause is unknown; however, there is evidence to suggest circadian and sleep structure differences, structural brain changes, and neurochemical changes may contribute to the development and expression of this disease. The approach to treatment can be challenging owing to a limited number of approved treatments (calcium, magnesium, potassium, and sodium oxybates) in idiopathic hypersomnia. However, consideration of therapies shown to improve excessive daytime sleepiness in other disorders is frequently employed. Future directions require a clear consensus on the defining characteristics of idiopathic hypersomnia to enhance the opportunity for improved recognition, diagnosis, and treatment strategies to be established. This article provides a historical review of the evolving diagnostic classification of idiopathic hypersomnia, potential insights to the underlying pathophysiology, and a summary of proposed approaches for diagnosis and therapeutic intervention.
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Affiliation(s)
- Anne Marie Morse
- Department of Child Neurology and Pediatric Sleep Medicine, Geisinger Commonwealth School of Medicine, Geisinger Medical Center, Janet Weis Children's Hospital, 100 N. Academy Ave, MC 14-05, Danville, PA, 17820, USA.
| | - Sreelatha Naik
- Department of Sleep Medicine, Pulmonary and Critical Care, Geisinger Wyoming Valley Medical Center, Wilkes-Barre, PA, USA
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Gumeler E, Aygun E, Tezer FI, Saritas EU, Oguz KK. Assessment of glymphatic function in narcolepsy using DTI-ALPS index. Sleep Med 2023; 101:522-527. [PMID: 36535226 DOI: 10.1016/j.sleep.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 12/02/2022] [Accepted: 12/04/2022] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Sleep is a modulator of glymphatic activity which is altered in various sleep disorders. Narcolepsy is a sleep disorder characterized by excessive daytime sleepiness (EDS), rapid onset of rapid eye movement (REM) sleep, cataplexy, disturbed night sleep with fragmentation. It is categorized into two types, type 1 (NT1) and type 2 (NT2) depending on the presence of cataplexy and/or absence of orexin. We sought for alterations in glymphatic activity in narcoleptic patients using diffusion tensor imaging (DTI) along perivascular space (ALPS) index on magnetic resonance imaging (MRI). MATERIAL AND METHODS Adult patients diagnosed with NT1 or NT2 who had polysomnography (PSG) and MRI with DTI were included in the study. Sleep recording included Epworth Sleepiness Scale (ESS) score, sleep latency during multiple sleep latency test (MSLT), sleep efficiency during night PSG, wake after sleep onset (WASO), REM sleep latency during PSG, percentage of non-REM (NREM), REM sleep and wakefulness during night PSG. DTI-ALPS index was calculated for each patient and age-sex matched healthy control(HC)s. RESULTS The study group was composed of 25 patients [F/M = 15/10, median age = 34 (29.5-44.5)], 14 with NT1 and 11 with NT2 disease. ESS, WASO and percentage of wakefulness were significantly higher in NT1 patients (p < 0.05). Mean DTI-ALPS was not significantly different neither between narcoleptic patients and HCs, nor between NT1 and NT2 patients (all, p > 0.05). However, DTI-ALPS was negatively correlated with WASO (r = -0.745, p = 0.013) and percentage of wakefulness (r = -0.837, p = 0.005) in NT1 patients. DTI-ALPS correlated negatively with percentage of N1 sleep (r = -0.781, p = 0.005) but positively with REM percentage (r = 0.618, p = 0.043) in NT2 patients. CONCLUSION In this study, DTI-ALPS was not significantly different in narcoleptic patients than the HCs. However, the glymphatic index as assessed by DTI-ALPS correlated with PSG parameters; negatively with WASO, percentage of wakefulness in NT1, percentage of N1 sleep in NT2, and positively with REM sleep in NT2. A tendency for a reduction in DTI-ALPS in NT1 patients compared to both NT2 patients and HCs was also found. These findings might show the first evidence of an alteration of glymphatic activity, especially in NT1 patients, thus warrant further prospective studies in larger size of narcoleptic patient cohorts.
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Affiliation(s)
- Ekim Gumeler
- Hacettepe University, Faculty of Medicine, Department of Radiology, Ankara, Turkey.
| | - Elif Aygun
- Department of Electrical and Electronics Engineering, Bilkent University, National Magnetic Resonance Research Center UMRAM, Ankara, Turkey
| | - F Irsel Tezer
- Hacettepe University, Faculty of Medicine, Department of Neurology, Ankara, Turkey
| | - Emine Ulku Saritas
- Department of Electrical and Electronics Engineering, Bilkent University, National Magnetic Resonance Research Center UMRAM, Ankara, Turkey
| | - Kader K Oguz
- Hacettepe University, Faculty of Medicine, Department of Radiology, Ankara, Turkey
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5
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Wu L, Zhan Q, Liu Q, Xie S, Tian S, Xie L, Wu W. Abnormal Regional Spontaneous Neural Activity and Functional Connectivity in Unmedicated Patients with Narcolepsy Type 1: A Resting-State fMRI Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15482. [PMID: 36497558 PMCID: PMC9738657 DOI: 10.3390/ijerph192315482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 11/04/2022] [Accepted: 11/18/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Previous Resting-state functional magnetic resonance imaging (fMRI) studies have mainly focused on cerebral functional alteration in processing different emotional stimuli in patients with narcolepsy type 1 (NT1), but were short of exploration of characteristic brain activity and its remote interaction patterns. This study aimed to investigate the spontaneous blood oxygen fluctuations at rest and to elucidate the neural mechanisms underlying neuropsychiatric behavior. METHOD A total of 18 unmedicated patients with NT1 and matched healthy individuals were recruited in a resting-state fMRI study. Magnetic resonance imaging (MRI) data were first analyzed using fractional low-frequency amplitude of low-frequency fluctuation (fALFF) to detect changes in local neural activity, and regions with group differences were taken as regions of interest (ROIs). Secondly, functional connectivity (FC) analysis was used to explore altered connectivity between ROIs and other areas. Lastly, the relationship between functional brain activity and neuropsychiatric behaviors was analyzed with correlation analysis. RESULTS fALFF analysis revealed enhanced neural activity in bilateral fusiform gyrus (FFG), right precentral gyrus, and left postcentral gyrus (PoCG) in the NT1 group. The patients indicated reduced activity in the bilateral temporal pole middle temporal gyrus (TPOmid), left caudate nucleus (CAU), left parahippocampus, left precuneus (PCUN), right amygdala, and right anterior cingulate and paracingulate gyri. ESS score was negatively correlated with fALFF in the right FFG. The NT1 group revealed decreased connectivity between left TPOmid and right PoCG, the bilateral middle frontal gyrus, left superior frontal gyrus, medial, and right supramarginal gyrus. Epworth Sleepiness Scale (ESS) was negatively correlated with FC of the left TPOmid with left putamen (PUT) in NT1. Compared with healthy controls (HCs), enhanced FC of the left CAU with right FFG was positively associated with MSLT-SOREMPs in patients. Furthermore, increased FC of the left PCUN with right PoCG was positively correlated with SDS score. CONCLUSIONS We found that multiple functional activities related to the processing of emotional regulation and sensory information processing were abnormal, and some were related to clinical characteristics. fALFF in the left postcentral or right precentral gyrus may be used as a biomarker of narcolepsy, whereas fALFF in the right fusiform and the FC strength of the left temporal pole middle temporal gyrus with the putamen may be clinical indicators to assess the drowsiness severity of narcolepsy.
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Affiliation(s)
- Lanxiang Wu
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - Qingqing Zhan
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - Qian Liu
- Imaging Department, The Second Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - Suheng Xie
- Imaging Department, The Second Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - Sheng Tian
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - Liang Xie
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - Wei Wu
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang 330006, China
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Varughese RT, Kothare SV, Franceschi AM. 18F-FDG Brain PET Findings in Narcolepsy Type 2. Clin Nucl Med 2022; 47:e559-e561. [PMID: 35797634 DOI: 10.1097/rlu.0000000000004264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT A 16-year-old adolescent boy with extensive travel throughout West Africa presented with a 6-year history of social withdrawal, anhedonia, and daytime sleepiness. The patient's electroencephalography was normal. Initial MRI revealed small pituitary gland and left temporal developmental venous anomaly. Subsequently obtained 18F-FDG brain PET was notable for markedly severe hypometabolism in the brainstem. Further workup revealed a normal orexin, autoimmune encephalitis panel, and negative titers for Trypanosoma brucei and cruzi in the CSF. Outpatient sleep study showed mild obstructive sleep apnea, and multiple sleep latency test revealed reduced mean sleep latency at 7 minutes with sleep-onset REM in 3/5 naps, findings consistent with narcolepsy type 2.
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Affiliation(s)
- Robin T Varughese
- From the Department of Neurology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, The Feinstein Institutes for Medical Research, Manhasset, NY
| | - Sanjeev V Kothare
- From the Department of Neurology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, The Feinstein Institutes for Medical Research, Manhasset, NY
| | - Ana Marija Franceschi
- Neuroradiology Division, Department of Radiology, Northwell Health/Donald and Barbara Zucker School of Medicine, Lenox Hill Hospital, New York, NY
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7
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Park HR, Kim HR, Seong JK, Joo EY. Localizing deficits in white matter tracts of patients with narcolepsy with cataplexy: tract-specific statistical analysis. Brain Imaging Behav 2021; 14:1674-1681. [PMID: 31115860 DOI: 10.1007/s11682-019-00100-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
White matter alterations related to hypocretin pathway have been less evaluated in patients who have narcolepsy with cataplexy (NC), as compared to the identified exploration of gray matter and have varied among structural brain magnetic resonance imaging studies. The aim of this study was to investigate the disruption of specific white matter tracts in drug-naïve patients with NC, by using a tract-specific statistical analysis (TSSA). Forty drug-naïve NC patients with cataplexy and 42 heathy controls were enrolled in the study. All participants completed diffusion weighted imaging, polysomnography, and neuropsychological testing. At that time, we automatically identified fourteen major fiber tracts using diffusion tensor imaging techniques and analyzed the group comparison of fractional anisotropy (FA) values for each tract between the NC and controls, controlling for the participant's age and gender. The mean age of the NC patients was 26.9 years and the onset age of daytime sleepiness and cataplexy was 16.7 years and 19.9 years, respectively. Relative to the controls, the NC patients showed that there were identified decreased FA values in the bilateral inferior fronto-occipital fasciculus (IFO). The Epworth sleepiness scale was positively correlated with FA values for the left IFO and right cingulate. The REM sleep latency was positively correlated with FA values for the left IFO, cingulate, and uncinate fasciculus in patients. This TSSA study revealed disintegration of the IFO in the NC patients and suggested that disintegration of WM tracts connected to the frontal cortex contributes to clinical manifestations of narcolepsy.
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Affiliation(s)
- Hea Ree Park
- Department of Neurology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, South Korea
| | - Hye Ryun Kim
- School of Biomedical Engineering, Korea University, 145, Anam-ro, Anam-dong 5-ga, Seongbuk-gu, Seoul, 02841, Republic of Korea.,Global Health Technology Research Center, College of Health Science, Korea University, Seoul, South Korea
| | - Joon-Kyung Seong
- Global Health Technology Research Center, College of Health Science, Korea University, Seoul, South Korea.
| | - Eun Yeon Joo
- Department of Neurology, Neuroscience Center, Samsung Biomedical Research Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea. .,Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, South Korea.
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8
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Trotti LM, Saini P, Crosson B, Meltzer CC, Rye DB, Nye JA. Regional brain metabolism differentiates narcolepsy type 1 and idiopathic hypersomnia. Sleep 2021; 44:6161267. [PMID: 33693888 DOI: 10.1093/sleep/zsab050] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 02/13/2021] [Indexed: 12/18/2022] Open
Abstract
STUDY OBJECTIVES Daytime sleepiness is a manifestation of multiple sleep and neurologic disorders. Few studies have assessed patterns of regional brain metabolism across different disorders of excessive daytime sleepiness. One such disorder, idiopathic hypersomnia (IH), is particularly understudied. METHODS People with IH, narcolepsy (NT1), and non-sleepy controls underwent [ 18F]-fluorodeoxyglucose (FDG) positron emission tomography (PET) with electroencephalography (EEG). Participants were instructed to resist sleep and were awoken if sleep occurred. Voxel-wise parametric analysis identified clusters that significantly differed between each pair of groups, with a minimum cluster size of 100 voxels at a cluster detection threshold of p < 0.005. Correlations between glucose metabolism and sleep characteristics were evaluated. RESULTS Participants (77% women) had IH (n = 16), NT1 (n = 14), or were non-sleepy controls (n = 9), whose average age was 33.8 (+/-10.7) years. Compared to controls, NT1 participants demonstrated hypermetabolism in fusiform gyrus, middle occipital gyrus, superior and middle temporal gyri, insula, cuneus, precuneus, pre- and post-central gyri, and culmen. Compared to controls, IH participants also demonstrated hypermetabolism in precuneus, inferior parietal lobule, superior and middle temporal gyri, and culmen. Additionally, IH participants demonstrated altered metabolism of the posterior cingulate. Most participants fell asleep. Minutes of N1 during uptake was significantly negatively correlated with metabolism of the middle temporal gyrus. CONCLUSION NT1 and IH demonstrate somewhat overlapping, but distinct, patterns of regional metabolism.
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Affiliation(s)
- Lynn Marie Trotti
- Department of Neurology, Emory University School of Medicine.,Emory Sleep Center, Emory Healthcare
| | - Prabhjyot Saini
- Department of Neurology, Emory University School of Medicine
| | - Bruce Crosson
- Department of Neurology, Emory University School of Medicine.,Alanta Veterans Affairs Center for Visual and Neurocognitive Rehabilitation
| | - Carolyn C Meltzer
- Department of Radiology and Imaging Sciences, Emory University School of Medicine
| | - David B Rye
- Department of Neurology, Emory University School of Medicine.,Emory Sleep Center, Emory Healthcare
| | - Jonathon A Nye
- Department of Radiology and Imaging Sciences, Emory University School of Medicine
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Gool JK, Cross N, Fronczek R, Lammers GJ, van der Werf YD, Dang-Vu TT. Neuroimaging in Narcolepsy and Idiopathic Hypersomnia: from Neural Correlates to Clinical Practice. CURRENT SLEEP MEDICINE REPORTS 2020. [DOI: 10.1007/s40675-020-00185-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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10
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Cavaliere C, Longarzo M, Fogel S, Engström M, Soddu A. Neuroimaging of Narcolepsy and Primary Hypersomnias. Neuroscientist 2020; 26:310-327. [PMID: 32111133 DOI: 10.1177/1073858420905829] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Advances in neuroimaging open up the possibility for new powerful tools to be developed that potentially can be applied to clinical populations to improve the diagnosis of neurological disorders, including sleep disorders. At present, the diagnosis of narcolepsy and primary hypersomnias is largely limited to subjective assessments and objective measurements of behavior and sleep physiology. In this review, we focus on recent neuroimaging findings that provide insight into the neural basis of narcolepsy and the primary hypersomnias Kleine-Levin syndrome and idiopathic hypersomnia. We describe the role of neuroimaging in confirming previous genetic, neurochemical, and neurophysiological findings and highlight studies that permit a greater understanding of the symptoms of these sleep disorders. We conclude by considering some of the remaining challenges to overcome, the existing knowledge gaps, and the potential role for neuroimaging in understanding the pathogenesis and clinical features of narcolepsy and primary hypersomnias.
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Affiliation(s)
| | | | - Stuart Fogel
- Brain and Mind Institute, Western University, London, Ontario, Canada.,School of Psychology, University of Ottawa, Ottawa, Ontario, Canada.,Sleep Unit, The Royal's Institute for Mental Health Research, University of Ottawa, Ottawa, Ontario, Canada.,University of Ottawa Brain and Mind Research Institute, Ottawa, Ontario, Canada
| | - Maria Engström
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.,Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Andrea Soddu
- Brain and Mind Institute, Western University, London, Ontario, Canada.,Physics & Astronomy Department, Brain and Mind Institute, Western University, London, Ontario, Canada
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11
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Gool JK, Fronczek R, Leemans A, Kies DA, Lammers GJ, Van der Werf YD. Widespread white matter connectivity abnormalities in narcolepsy type 1: A diffusion tensor imaging study. NEUROIMAGE-CLINICAL 2019; 24:101963. [PMID: 31382241 PMCID: PMC6698319 DOI: 10.1016/j.nicl.2019.101963] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 06/20/2019] [Accepted: 07/26/2019] [Indexed: 11/25/2022]
Abstract
Narcolepsy type 1 is caused by a selective loss of hypothalamic hypocretin-producing neurons, resulting in severely disturbed sleep-wake control and cataplexy. Hypocretin-producing neurons project widely throughout the brain, influencing different neural networks. We assessed the extent of microstructural white matter organization and brain-wide structural connectivity abnormalities in a homogeneous group of twelve drug-free patients with narcolepsy type 1 and eleven matched healthy controls using diffusion tensor imaging with multimodal analysis techniques. First, tract-based spatial statistics (TBSS) was carried out using fractional anisotropy (FA) and mean, axial and radial diffusivity (MD, AD, RD). Second, quantitative analyses of mean FA, MD, AD and RD were conducted in predefined regions-of-interest, including sleep-wake regulation-related, limbic and reward system areas. Third, we performed hypothalamus-seeded tractography towards the thalamus, amygdala and midbrain. TBSS analyses yielded brain-wide significantly lower FA and higher RD in patients. Localized significantly lower FA and higher RD in the left ventral diencephalon and lower AD in the midbrain, were seen in patients. Lower FA was also found in patients in left hypothalamic fibers connecting with the midbrain. No significant MD and AD differences nor a correlation with disease duration were found. The brain-wide, localized ventral diencephalon (comprising the hypothalamus and different sleep- and motor-related nuclei) and hypothalamic connectivity differences clearly show a heretofore underestimated direct and/or indirect effect of hypocretin deficiency on microstructural white matter composition, presumably resulting from a combination of lower axonal density, lower myelination and/or greater axon diameter. Patients with narcolepsy type 1 have brain-wide microstructural white matter disruptions. Patients have overall lower fractional anisotropy and higher radial diffusivity. Fractional anisotropy was most prominently lower in the left ventral diencephalon. Lower fractional anisotropy was seen in patients in tracts connecting the left hypothalamus with the midbrain. Patients suffer from a combination of lower axonal density, lower myelination and/or greater axon diameter.
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Affiliation(s)
- Jari K Gool
- Department of Anatomy and Neurosciences, Amsterdam UMC (Location VUmc), Amsterdam, the Netherlands; Sleep-Wake Centre, Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, the Netherlands; Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands.
| | - Rolf Fronczek
- Sleep-Wake Centre, Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, the Netherlands; Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | - Alexander Leemans
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Dennis A Kies
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Gert Jan Lammers
- Sleep-Wake Centre, Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, the Netherlands; Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | - Ysbrand D Van der Werf
- Department of Anatomy and Neurosciences, Amsterdam UMC (Location VUmc), Amsterdam, the Netherlands
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12
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Joo EY. Updates on Structural Neuroimaging of Narcolepsy with Cataplexy. PRECISION AND FUTURE MEDICINE 2019. [DOI: 10.23838/pfm.2018.00149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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13
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Takahashi T, Noriaki S, Matsumura M, Li C, Takahashi K, Nishino S. Advances in pharmaceutical treatment options for narcolepsy. Expert Opin Orphan Drugs 2018. [DOI: 10.1080/21678707.2018.1521267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Tatsunori Takahashi
- Stanford University Sleep and Circadian Neurobiology Laboratory, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Sakai Noriaki
- Stanford University Sleep and Circadian Neurobiology Laboratory, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Mari Matsumura
- Stanford University Sleep and Circadian Neurobiology Laboratory, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Chenyu Li
- Stanford University Sleep and Circadian Neurobiology Laboratory, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Kayo Takahashi
- Stanford University Sleep and Circadian Neurobiology Laboratory, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Seiji Nishino
- Stanford University Sleep and Circadian Neurobiology Laboratory, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, USA
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Tezer FI, Erdal A, Gumusyayla S, Has AC, Gocmen R, Oguz KK. Differences in diffusion tensor imaging changes between narcolepsy with and without cataplexy. Sleep Med 2018; 52:128-133. [PMID: 30321819 DOI: 10.1016/j.sleep.2018.08.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 07/29/2018] [Accepted: 08/27/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The distinctive clinical finding of Type 1 narcolepsy compared to Type 2 is the presence of cataplexy. Several neuroimaging studies have also reported abnormalities in narcolepsy patients with or without cataplexy. However, there are conflicting results to differentiate them. In this study, we aimed to clarify the white matter changes in narcolepsy patients both with and without cataplexy and compared them with healthy adults to evaluate microstructural differences in the brain. METHODS Eleven narcolepsy patients with cataplexy (NC), 12 narcolepsy patients without cataplexy (NOC) and healthy age- and gender-matched controls (N = 16) were studied. Whole-brain diffusion tensor imaging (DTI) was obtained and tract-based spatial statistics were used to localize white matter abnormalities. RESULTS Compared with the healthy controls, both NC and NOC patients exhibited significant fractional anisotropy (FA) decreases in the bilateral cerebellar hemispheres, bilateral thalami, the corpus callosum and left anterior-medial temporal white matter. Compared with the controls, the NC patients' FA values were also decreased in the midbrain. No significant correlations were found between FA values and clinical-polysomnographic variables. CONCLUSION This DTI study has demonstrated white matter abnormalities in the midbrain-brainstem regions as a distinctive finding of narcolepsy patients with cataplexy. Involvement of bilateral temporal lobes with greater changes on the left lobe is also a supporting finding of patients with cataplexy. DTI changes in the midbrain-brainstem and bilateral temporal lobes can be signs of different pathological mechanisms in these patients.
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Affiliation(s)
- F Irsel Tezer
- Hacettepe University, Faculty of Medicine, Department of Neurology, Ankara, Turkey.
| | - Abidin Erdal
- Hacettepe University, Faculty of Medicine, Department of Neurology, Ankara, Turkey
| | - Sadiye Gumusyayla
- Hacettepe University, Faculty of Medicine, Department of Neurology, Ankara, Turkey
| | - Arzu Ceylan Has
- University Hospital Hamburg-Eppendorf, Institute of Neuroimmunology and Multiple Sclerosis, Hamburg, Germany
| | - Rahsan Gocmen
- Hacettepe University, Faculty of Medicine, Department of Radiology, Ankara, Turkey
| | - Kader K Oguz
- Hacettepe University, Faculty of Medicine, Department of Radiology, Ankara, Turkey
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15
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Juvodden HT, Alnæs D, Lund MJ, Agartz I, Andreassen OA, Dietrichs E, Thorsby PM, Westlye LT, Knudsen S. Widespread white matter changes in post-H1N1 patients with narcolepsy type 1 and first-degree relatives. Sleep 2018; 41:5054638. [PMID: 30016530 DOI: 10.1093/sleep/zsy145] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Indexed: 11/12/2022] Open
Affiliation(s)
- Hilde T Juvodden
- Department of Rare Disorders, Norwegian Centre of Expertise for Neurodevelopmental Disorders and Hypersomnias (NevSom), Oslo University Hospital, Ullevål, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Dag Alnæs
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Martina J Lund
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ingrid Agartz
- NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Ole A Andreassen
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Espen Dietrichs
- Department of Neurology, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Per M Thorsby
- Department of Medical Biochemistry, Hormone Laboratory, Oslo University Hospital, Aker, Norway
| | - Lars T Westlye
- NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Stine Knudsen
- Department of Rare Disorders, Norwegian Centre of Expertise for Neurodevelopmental Disorders and Hypersomnias (NevSom), Oslo University Hospital, Ullevål, Norway
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16
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17
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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: 23] [Impact Index Per Article: 3.8] [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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18
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Boucetta S, Montplaisir J, Zadra A, Lachapelle F, Soucy JP, Gravel P, Dang-Vu TT. Altered Regional Cerebral Blood Flow in Idiopathic Hypersomnia. Sleep 2018; 40:4092855. [PMID: 28958044 DOI: 10.1093/sleep/zsx140] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Study Objectives Idiopathic hypersomnia is characterized by excessive daytime sleepiness, despite normal or long sleep time. Its pathophysiological mechanisms remain unclear. This pilot study aims at characterizing the neural correlates of idiopathic hypersomnia using single photon emission computed tomography. Methods Thirteen participants with idiopathic hypersomnia and 16 healthy controls were scanned during resting wakefulness using a high-resolution single photon emission computed tomography scanner with 99mTc-ethyl cysteinate dimer to assess cerebral blood flow. The main analysis compared regional cerebral blood flow distribution between the two groups. Exploratory correlations between regional cerebral blood flow and clinical characteristics evaluated the functional correlates of those brain perfusion patterns. Significance was set at p < .05 after correction for multiple comparisons. Results Participants with idiopathic hypersomnia showed regional cerebral blood flow decreases in medial prefrontal cortex and posterior cingulate cortex and putamen, as well as increases in amygdala and temporo-occipital cortices. Lower regional cerebral blood flow in the medial prefrontal cortex was associated with higher daytime sleepiness. Conclusions These preliminary findings suggest that idiopathic hypersomnia is characterized by functional alterations in brain areas involved in the modulation of vigilance states, which may contribute to the daytime symptoms of this condition. The distribution of regional cerebral blood flow changes was reminiscent of the patterns associated with normal non-rapid-eye-movement sleep, suggesting the possible presence of incomplete sleep-wake transitions. These abnormalities were strikingly distinct from those induced by acute sleep deprivation, suggesting that the patterns seen here might reflect a trait associated with idiopathic hypersomnia rather than a non-specific state of sleepiness.
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Affiliation(s)
- Soufiane Boucetta
- Center for Studies in Behavioral Neurobiology and Department of Exercise Science, Concordia University, Montreal, Quebec, Canada.,PERFORM Centre, Concordia University, Montreal, Quebec, Canada.,Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, Montréal, Quebec, Canada.,Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada
| | - Jacques Montplaisir
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada.,Department of Psychiatry, Université de Montréal, Montreal, Quebec, Canada
| | - Antonio Zadra
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada.,Department of Psychology, Université de Montréal, Montreal, Quebec, Canada
| | - Francis Lachapelle
- Center for Studies in Behavioral Neurobiology and Department of Exercise Science, Concordia University, Montreal, Quebec, Canada.,PERFORM Centre, Concordia University, Montreal, Quebec, Canada.,Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, Montréal, Quebec, Canada
| | - Jean-Paul Soucy
- PERFORM Centre, Concordia University, Montreal, Quebec, Canada.,McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Paul Gravel
- PERFORM Centre, Concordia University, Montreal, Quebec, Canada.,McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Thien Thanh Dang-Vu
- Center for Studies in Behavioral Neurobiology and Department of Exercise Science, Concordia University, Montreal, Quebec, Canada.,PERFORM Centre, Concordia University, Montreal, Quebec, Canada.,Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, Montréal, Quebec, Canada.,Department of Neurosciences, Université de Montréal, Montreal, Quebec, Canada
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19
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Nakamura M, Yanagihara M, Matsui K, Kobayashi M, Inoue Y. Brain microstructural alterations in patients with severe obstructive sleep apnea: a preliminary diffusion tensor imaging study. Sleep Biol Rhythms 2017. [DOI: 10.1007/s41105-017-0113-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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20
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Dauvilliers Y, Evangelista E, de Verbizier D, Barateau L, Peigneux P. [18F]Fludeoxyglucose-Positron Emission Tomography Evidence for Cerebral Hypermetabolism in the Awake State in Narcolepsy and Idiopathic Hypersomnia. Front Neurol 2017; 8:350. [PMID: 28775709 PMCID: PMC5517406 DOI: 10.3389/fneur.2017.00350] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 07/04/2017] [Indexed: 12/02/2022] Open
Abstract
Background Changes in structural and functional central nervous system have been reported in narcolepsy, with large discrepancies between studies. No study has investigated yet spontaneous brain activity at wake in idiopathic hypersomnia (IH). We compared relative changes in regional brain metabolism in two central hypersomnia conditions with different clinical features, namely narcolepsy type 1 (NT1) and IH, and in healthy controls. Methods Sixteen patients [12 males, median age 30 years (17–78)] with NT1, nine patients [2 males, median age 27 years (20–60)] with IH and 19 healthy controls [16 males, median age 36 years (17–78)] were included. 18F-fludeoxyglucose positron emission tomography (PET) was performed in all drug-free subjects under similar conditions and instructions to stay in a wake resting state. Results We found increased metabolism in the anterior and middle cingulate and the insula in the two pathological conditions as compared to healthy controls. The reverse contrast failed to evidence hypometabolism in patients vs. controls. Comparisons between patient groups were non-significant. At sub-statistical threshold, we found higher right superior occipital gyrus glucose metabolism in narcolepsy and higher middle orbital cortex and supplementary motor area metabolism in IH, findings that require further confirmation. Conclusion There is significant hypermetabolism in narcolepsy and IH in the wake resting state in a set of brain regions constitutive of the salience cortical network that may reflect a compensatory neurocircuitry activity secondary to sleepiness. Metabolic differences between the two disorders within the executive-control network may be a signature of abnormally functioning neural system leading to persistent drowsiness typical of IH.
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Affiliation(s)
- Yves Dauvilliers
- Centre de Référence Nationale Maladie Rare, Narcolepsie et Hypersomnie Idiopathique, Unité de Sommeil, Hôpital Gui-de-Chauliac, CHU Montpellier, Montpellier, France.,INSERM U1061, Montpellier, France
| | - Elisa Evangelista
- Centre de Référence Nationale Maladie Rare, Narcolepsie et Hypersomnie Idiopathique, Unité de Sommeil, Hôpital Gui-de-Chauliac, CHU Montpellier, Montpellier, France.,INSERM U1061, Montpellier, France
| | - Delphine de Verbizier
- Service de Médecine Nucléaire, Hôpital Gui-de-Chauliac, CHU Montpellier, Montpellier, France
| | - Lucie Barateau
- Centre de Référence Nationale Maladie Rare, Narcolepsie et Hypersomnie Idiopathique, Unité de Sommeil, Hôpital Gui-de-Chauliac, CHU Montpellier, Montpellier, France.,INSERM U1061, Montpellier, France
| | - Philippe Peigneux
- UR2NF, Neuropsychology and Functional Neuroimaging Research Unit, Centre de Recherches Cognition et Neurosciences (CRCN), ULB Neurosciences Institute (UNI), Université Libre de Bruxelles, Brussels, Belgium
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21
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Black SW, Yamanaka A, Kilduff TS. Challenges in the development of therapeutics for narcolepsy. Prog Neurobiol 2015; 152:89-113. [PMID: 26721620 DOI: 10.1016/j.pneurobio.2015.12.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 11/14/2015] [Accepted: 12/04/2015] [Indexed: 01/19/2023]
Abstract
Narcolepsy is a neurological disorder that afflicts 1 in 2000 individuals and is characterized by excessive daytime sleepiness and cataplexy-a sudden loss of muscle tone triggered by positive emotions. Features of narcolepsy include dysregulation of arousal state boundaries as well as autonomic and metabolic disturbances. Disruption of neurotransmission through the hypocretin/orexin (Hcrt) system, usually by degeneration of the HCRT-producing neurons in the posterior hypothalamus, results in narcolepsy. The cause of Hcrt neurodegeneration is unknown but thought to be related to autoimmune processes. Current treatments for narcolepsy are symptomatic, including wake-promoting therapeutics that increase presynaptic dopamine release and anticataplectic agents that activate monoaminergic neurotransmission. Sodium oxybate is the only medication approved by the US Food and Drug Administration that alleviates both sleep/wake disturbances and cataplexy. Development of therapeutics for narcolepsy has been challenged by historical misunderstanding of the disease, its many disparate symptoms and, until recently, its unknown etiology. Animal models have been essential to elucidating the neuropathology underlying narcolepsy. These models have also aided understanding the neurobiology of the Hcrt system, mechanisms of cataplexy, and the pharmacology of narcolepsy medications. Transgenic rodent models will be critical in the development of novel therapeutics for the treatment of narcolepsy, particularly efforts directed to overcome challenges in the development of hypocretin replacement therapy.
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Affiliation(s)
- Sarah Wurts Black
- Center for Neuroscience, Biosciences Division, SRI International, Menlo Park, CA 94025, USA
| | - Akihiro Yamanaka
- Research Institute of Environmental Medicine, Nagoya University, Nagoya 464-8601, Japan
| | - Thomas S Kilduff
- Center for Neuroscience, Biosciences Division, SRI International, Menlo Park, CA 94025, USA.
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22
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Park YK, Kwon OH, Joo EY, Kim JH, Lee JM, Kim ST, Hong SB. White matter alterations in narcolepsy patients with cataplexy: tract-based spatial statistics. J Sleep Res 2015; 25:181-9. [PMID: 26610427 DOI: 10.1111/jsr.12366] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 10/07/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Yun K. Park
- Department of Neurology; Neuroscience Center; Sungkyunkwan University School of Medicine; Seoul Korea
| | - Oh-Hun Kwon
- Computational NeuroImage Analysis Laboratory; Department of Biomedical Engineering; Hanyang University; Seoul Korea
| | - Eun Yeon Joo
- Department of Neurology; Neuroscience Center; Sungkyunkwan University School of Medicine; Seoul Korea
- Department of Health Sciences and Technology; SAIHST; Sungkyunkwan University; Seoul Korea
| | - Jae-Hun Kim
- Department of Radiology; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul Korea
| | - Jong M. Lee
- Computational NeuroImage Analysis Laboratory; Department of Biomedical Engineering; Hanyang University; Seoul Korea
| | - Sung T. Kim
- Department of Radiology; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul Korea
| | - Seung B. Hong
- Department of Neurology; Neuroscience Center; Sungkyunkwan University School of Medicine; Seoul Korea
- Department of Health Sciences and Technology; SAIHST; Sungkyunkwan University; Seoul Korea
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23
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Chen Q, de Lecea L, Hu Z, Gao D. The hypocretin/orexin system: an increasingly important role in neuropsychiatry. Med Res Rev 2014; 35:152-97. [PMID: 25044006 DOI: 10.1002/med.21326] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Hypocretins, also named as orexins, are excitatory neuropeptides secreted by neurons specifically located in lateral hypothalamus and perifornical areas. Orexinergic fibers are extensively distributed in various brain regions and involved in a number of physiological functions, such as arousal, cognition, stress, appetite, and metabolism. Arousal is the most important function of orexin system as dysfunction of orexin signaling leads to narcolepsy. In addition to narcolepsy, orexin dysfunction is associated with serious neural disorders, including addiction, depression, and anxiety. However, some results linking orexin with these disorders are still contradictory, which may result from differences of detection methods or the precision of tools used in measurements; strategies targeted to orexin system (e.g., antagonists to orexin receptors, gene delivery, and cell transplantation) are promising new tools for treatment of neuropsychiatric disorders, though studies are still in a stage of preclinical or clinical research.
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Affiliation(s)
- Quanhui Chen
- Department of Physiology, Third Military Medical University, Chongqing 400038, China; Department of Sleep and Psychology, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing 400038, China
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