Narcolepsy Research Paper

Narcolepsy is a chronic brain disorder that affects a person’s ability to stay awake during the day. Some symptoms include poor control of day-time sleepiness that consists of sudden spurts of extreme tiredness that may even be accompanied by uncontrollable sleep. The person may fall asleep for a few seconds to minutes while doing everyday activities. Hallucinations and partial to full paralysis are also possible symptoms that can occur before or after uncontrolled sleep spells. Interestingly enough people with narcolepsy spend around the same amount of time sleeping as any other person would. The sleep that they do get is just more spread out than that of a healthy person. A person with narcolepsy often has trouble sleeping at night and may
also have other sleeping disorders. The average amount of sleep an adult gets per twenty-four hour period is about eight hours, that is divided into around six full sleep cycles that include a period of non-rapid eye movement (NREM) and a period of rapid eye movement (REM). People with narcolepsy generally fall asleep and go straight into REM sleep skipping NREM sleep altogether; this can be very harmful to the person because this does not give the brain and the body enough time to recover from the previous day. The symptoms of narcolepsy usually present themselves between the ages of seven and twenty-five but it is possible for the disorder to appear in older people.
The early onset of narcolepsy in children can affect a child’s ability to develop in social and academic settings. There are four main symptoms of narcolepsy; these include excessive daytime sleepiness (EDS), cataplexy, sleep paralysis, and hallucinations. The most common of these symptoms is EDS, people that experience EDS often report “mental cloudiness, lack of energy, a depressed mood, and/or extreme exhaustion” (Office) that accompanies the EDS. The involuntary episodes of sleep can sometimes be short lasting no more than a few seconds at a time but people report that after they awake from these sleeps that they feel refreshed and the feeling of drowsiness and fatigue usually subsides for an hour or two. EDS can be caused by an assortment of different medical conditions such as other sleep disorders, depression, anemia, and even consumption of caffeine, alcohol or nicotine. Sometimes automatic behavior can accompany EDS. During the periods of uncontrollable sleep the person may perform a normal everyday task such as writing or making a sandwich but after the episode have no memory of what happened. Narcolepsy is usually diagnosed because of the onset of EDS. Another common symptom of narcolepsy is cataplexy affecting about 70 percent of the people diagnosed. It is a sudden loss of muscle tone while the person is
awake and conscious. It can be as simple as sudden weakness in the muscle or be severe. In the most severe cases a person can become completely paralyzed unable to speak or move. Narcolepsy is caused by low levels of neurotransmitter hypocretin.
In some rare cases narcolepsy can be caused by a genetic defect that inhibits the normal production of hypocretin. Genetics does not seem to be a factor in acquiring narcolepsy but if close family members do have the disorder then statistically the risk is higher a developing narcolepsy. Studies have shown that “when cataplexy is present, the cause is most often the discrete loss of brain cells that produce hypocretin. Although the reason for such cell loss remains unknown, it appears to be autoimmune in nature” (Office). Scientists have made progress in understanding narcolepsy in the past few years and have identified genes strongly associated with the disorder. They have found that a majority of patients with narcolepsy “have a specific HLA gene variant called DQB1*0602” (Office). Scientists “believed that certain HLA and TCR subtypes increase susceptibility to an immune attack on hypocretin neurons in the hypothalamus, leading to degeneration of these important cells”
(Office). Diagnosis of narcolepsy is difficult because of all of the outside factors that can also effect the sleep cycle such as stress or diet. If cataplexy is not a present symptom then diagnosis of narcolepsy can only be made after all other causes of day-time sleepiness have been ruled out. Narcolepsy is usually diagnosed by the use of two main tests. The first is a polysomnogram (PSG), this test is run overnight. While the patient is asleep it takes continuous measurements and records any anomalies in the sleep cycle. A PSG also monitors heart and breathing rates, electrical activity in the brain using an electroencephalography and the activity of the nerves in the muscles through an electromyography. The usage of a PSG helps to reveal if REM sleep occurs at abnormal times during the sleep cycle. The second test that can be preformed is a multiple sleep latency test (MSLT). This test is administered during the day and measures how often a patient falls asleep and how long it takes them to fall asleep. It determines if REM sleep is occurring during inappropriate times of the day. The patient is asked to take four to five short naps over the course of the day during these naps the latency period is measured. The normal latency period is eight to twelve minutes if it takes the patient less than eight minutes to fall asleep it suggests the symptom of EDS. Sometimes human leukocyte antigen (HLA) typing can be done to help diagnose narcolepsy. A lumbar puncture is preformed to extract cerebrospinal fluid (CSF). The CSF is then tested and the level of hypocretin-1 is measured; if there are no other serious medical conditions present in the patient, then a low hypocretin-1 level can indicate narcolepsy. Narcolepsy has not been cured but the symptoms of EDS and cataplexy can be managed by the medications of Modafinil and sodium oxybate. Modafinil helps with improving alertness to reduce fatigue but must be monitored and comes with some side effects such as shakiness, disruption of night-time sleep and stomach aches. Sodium oxybate must be taken at night; it works as a sedative and helps to induce sleep but is not prescribed often due to safety concerns and tight restrictions. A study recently evaluated the health-related quality of life (HRQL) of children and adolescents diagnosed with narcolepsy using a questionnaire. The narcolepsy affected the children’s vitality and physical well being. The study showed that the narcoleptic patients had fewer extracurricular activities and less social interaction than the healthy subjects. The study also showed that many of the patients exhibited “social dysfunction” (Inocente) and could adverse side effects because of it, such as “deterioration in physical and psychosocial function as well as emotional health” (Inocente). This could seriously impact the quality of life for these patients and possibly worsen their condition. The symptom of EDS caused the children to score specifically lower in the section that measured energy and vitality. These children are at risk of developing behavioral problems and depression because of this disorder. The results showed that “depressive symptoms had a major impact on HRQL. Other factors such as hyperactivity, fatigue, EDS, and insomnia also negatively influenced HRQL” (Inocente). A clinical trial just assessed the risk of acquiring narcolepsy from the H1N1 vaccination. The study recorded information on patients that acquired narcolepsy that were exposed and unexposed to the vaccine. The result was “incidence of narcolepsy among narcoleptic subjects exposed or unexposed to vaccine” (Montplaisir).
I think that narcolepsy is an intriguing disorder that I would like to learn more about in the future. I was surprised to learn that it affected so many children and adolescents I expected the disorder to only affect the older population. I think that the journal article included some good insights on how narcolepsy effects the young patients diagnosed with it. I believe that these children should be pushed into more activities that involve more social interaction to help counter act the social dysfunction. I also believe that therapy should be a recommended treatment for these children to have an outlet and someone to talk to about what is going on with them. I was interested to see in the clinical trial that the H1N1 vaccination could be a cause of narcolepsy considering so many people receive those vaccinations. I wish, however, that the author of the clinical trial had been more specific on whether or not the vaccination could be an actual cause of the disorder.