Assuntos
Distúrbios do Sono por Sonolência Excessiva/diagnóstico , Narcolepsia/diagnóstico , Apneia Obstrutiva do Sono/diagnóstico , Adulto , Cefalometria , Diagnóstico Diferencial , Distúrbios do Sono por Sonolência Excessiva/tratamento farmacológico , Distúrbios do Sono por Sonolência Excessiva/etiologia , Humanos , Masculino , Metilfenidato/uso terapêutico , Narcolepsia/tratamento farmacológico , Narcolepsia/etiologia , Obesidade/complicações , Obesidade/diagnóstico , Polissonografia , Retrognatismo/complicações , Retrognatismo/diagnóstico , Apneia Obstrutiva do Sono/tratamento farmacológico , Apneia Obstrutiva do Sono/etiologia , Latência do SonoRESUMO
We studied multiple sclerosis (MS) patients with the HLA-DQB1*06:02 allele and compared them with MS patients who did not carry the HLA-DQB1*06:02 allele. We analyzed clinical and neurophysiological criteria for narcolepsy in six MS patients with HLA-DQB1*06:02, compared with 12 MS patients who were HLA-DQB1*06:02 non-carriers. Only two patients with HLA-DQB1*06:02 allele scored higher than 10 on the Epworth Sleepiness Scale. Polysomnography recording parameters and the multiple sleep latency test showed an absence of narcolepsy in the study group. Our study suggested no significant correlation between narcolepsy, MS and HLA-DQB1*06:02. The HLA-DQB1*06:02 allele alone was not sufficient to cause MS patients to develop narcolepsy.
Assuntos
Cadeias beta de HLA-DQ/genética , Esclerose Múltipla/complicações , Narcolepsia/etiologia , Adulto , Idoso , Feminino , Frequência do Gene , Genótipo , Humanos , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla/genética , Narcolepsia/diagnóstico , Narcolepsia/genética , Polissonografia , Adulto JovemRESUMO
ABSTRACT We studied multiple sclerosis (MS) patients with the HLA-DQB1*06:02 allele and compared them with MS patients who did not carry the HLA-DQB1*06:02 allele. We analyzed clinical and neurophysiological criteria for narcolepsy in six MS patients with HLA-DQB1*06:02, compared with 12 MS patients who were HLA-DQB1*06:02 non-carriers. Only two patients with HLA-DQB1*06:02 allele scored higher than 10 on the Epworth Sleepiness Scale. Polysomnography recording parameters and the multiple sleep latency test showed an absence of narcolepsy in the study group. Our study suggested no significant correlation between narcolepsy, MS and HLA-DQB1*06:02. The HLA-DQB1*06:02 allele alone was not sufficient to cause MS patients to develop narcolepsy.
RESUMO Pacientes com esclerose múltipla (EM) portadores do alelo HLA-DQB1*06:02 foram estudados e comparados com pacientes com EM mas que não são portadores do alelo HLA-DQB1*06:02. Os critérios clínicos e neurofisiológicos para narcolepsia foram analisados em pacientes com EM sendo 6 pacientes com o HLA-DQB1*06:02 comparados a 12 pacientes sem o HLA-DQB1*06:02. Somente 2 pacientes com EM e HLA-DQB1*06:02 tiveram escore maior que 10 na escala “Epworth Sleepiness Scale”. Os parâmetros da polissonografia e o teste de múltiplas latências do sono mostraram ausência de narcolepsia no grupo estudo. Nosso estudo não sugere correlações significantes entre narcolepsia, EM e HLA-DQB1*06:02. Somente o HLA-DQB1*06:02 não foi suficiente para desenvolver narcolepsia em pacientes com EM.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Adulto Jovem , Cadeias beta de HLA-DQ/genética , Esclerose Múltipla/complicações , Narcolepsia/etiologia , Polissonografia , Frequência do Gene , Genótipo , Esclerose Múltipla/genética , Narcolepsia/diagnóstico , Narcolepsia/genéticaRESUMO
Narcolepsy is a neurological disorder characterized by excessive daytime sleepiness. It is caused by the loss of orexin producing neurons in the lateral hypothalamus. Current evidences suggest an autoimmune mediated process causing the specific loss of orexin neurons. The high association of the disease with the HLA DQB1*06:02, as well as the link with environmental factors and are important clues supporting this theory. Recently, the association between the occurrence of the disease and vaccination campaign after the 2009 H1N1 pandemic highlighted the importance to increase the knowledge in the Pandora box of the vaccines. This review discusses the last finding regarding the pathogenesis of the disease and its relationship with the H1N1 vaccines.
Assuntos
Doenças Autoimunes/etiologia , Vírus da Influenza A Subtipo H1N1/imunologia , Vacinas contra Influenza/efeitos adversos , Narcolepsia/etiologia , Animais , Autoanticorpos/imunologia , Autoantígenos/imunologia , Doenças Autoimunes/genética , Doenças Autoimunes/imunologia , Humanos , Influenza Humana/imunologia , Narcolepsia/genética , Narcolepsia/imunologiaRESUMO
Este artigo relata as conclusões da reunião de consenso com médicos especialistas sobre diagnóstico de narcolepsia baseada na revisão dos artigos sobre narcolepsia listados no Medline entre 1980 e 2010. A narcolepsia é uma doença crônica de início entre a primeira e segunda décadas de vida do indivíduo. Os sintomas essenciais são cataplexia e sonolência excessiva. A cataplexia é definida como episódios súbitos, recorrentes e reversíveis de fraqueza da musculatura esquelética desencadeados por situações de conteúdo emocional. Os sintomas acessórios são alucinações hipnagógicas, paralisia do sono e sono fragmentado. Critérios de diagnóstico clínico de acordo com a Classificação Internacional dos Transtornos do Sono são de sonolência excessiva e cataplexia. Recomenda-se a realização de polissonografia seguida do teste de latência múltipla do sono em um laboratório de sono para confirmação e diagnóstico de comorbidades. Quando não houver cataplexia, deve haver duas ou mais sonecas com sono REM no teste de latência múltipla do sono. Tipagem HLA-DQB1*0602 positiva com níveis de hipocretina-1 abaixo de 110pg/mL devem estar presentes para o diagnóstico de narcolepsia sem cataplexia e sem sonecas com sono REM.
This manuscript contains the conclusion of the consensus meeting on the diagnosis of narcolepsy based on the review of Medline publications between 1980-2010. Narcolepsy is a chronic disorder with age at onset between the first and second decade of life. Essential narcolepsy symptoms are cataplexy and excessive sleepiness. Cataplexy is defined as sudden, recurrent and reversible attacks of muscle weakness triggered by emotions. Accessory narcolepsy symptoms are hypnagogic hallucinations, sleep paralysis and nocturnal fragmented sleep. The clinical diagnosis according to the International Classification of Sleep Disorders is the presence of excessive sleepiness and cataplexy. A full in-lab polysomnography followed by a multiple sleep latency test is recommended for the confirmation of the diagnosis and co-morbidities. The presence of two sleep-onset REM period naps in the multiple sleep latency test is diagnostic for cataplexy-free narcolepsy. A positive HLA-DQB1*0602 with lower than 110pg/mL level of hypocretin-1 in the cerebrospinal fluid is required for the final diagnosis of cataplexy- and sleep-onset REM period -free narcolepsy.
Assuntos
Humanos , Narcolepsia/diagnóstico , Brasil , Diagnóstico Diferencial , Narcolepsia/etiologia , Narcolepsia/genéticaRESUMO
This manuscript contains the conclusion of the consensus meeting on the diagnosis of narcolepsy based on the review of Medline publications between 1980-2010. Narcolepsy is a chronic disorder with age at onset between the first and second decade of life. Essential narcolepsy symptoms are cataplexy and excessive sleepiness. Cataplexy is defined as sudden, recurrent and reversible attacks of muscle weakness triggered by emotions. Accessory narcolepsy symptoms are hypnagogic hallucinations, sleep paralysis and nocturnal fragmented sleep. The clinical diagnosis according to the International Classification of Sleep Disorders is the presence of excessive sleepiness and cataplexy. A full in-lab polysomnography followed by a multiple sleep latency test is recommended for the confirmation of the diagnosis and co-morbidities. The presence of two sleep-onset REM period naps in the multiple sleep latency test is diagnostic for cataplexy-free narcolepsy. A positive HLA-DQB1*0602 with lower than 110pg/mL level of hypocretin-1 in the cerebrospinal fluid is required for the final diagnosis of cataplexy- and sleep-onset REM period -free narcolepsy.
Assuntos
Narcolepsia/diagnóstico , Brasil , Diagnóstico Diferencial , Humanos , Narcolepsia/etiologia , Narcolepsia/genéticaRESUMO
La narcolepsia es un trastorno del sueño caracterizado por excesiva somnolencia diurna, transiciones prematuras de la vigila al sueño de movimientos oculares rápidos, alucinaciones hipnagógicas y cataplexia. Evidencias experimentales indican que la narcolepsia en humanos es una enfermedad neurodegenerativa asociada con la pérdida de neuronas hipocretinérgicas localizadas en el hipotálamo lateral. Además, se sabe que los pacientes narcolépticos presentan reducción significativa en la concentración de hipocretinas (HCRT) en el líquido cefalorraquídeo. Nuestro laboratorio ha generado un nuevo modelo experimental de narcolepsia en rata, que nos permite estudiar la enfermedad desde un enfoque histológico y neuroquímico. Hemos demostrado que la toxina hipocretina 2/saporina destruye selectivamente las neuronas hipocretinérgicas. Además, la pérdida de estas neuronas induce un cuadro conductual similar al observado en otros modelos experimentales o narcolepsia en humanos. En la presente revisión abordamos aspectos generales de la narcolepsia, del sistema hipocretinérgico, así como de los modelos experimentales de narcolepsia y el uso de los transplantes como alternativa para tratar la enfermedad.
Narcolepsy is a chronic disease characterized by excessive somnolence, abrupt transitions from wakefulness to rapid eye movement sleep stage and cataplexy. Experimental evidence show that narcolepsy in humans is a neurodegenerative disease associated with the lost of hypocretin (HCRT) neurons in the lateral hypothalamus. Narcoleptic patients also display a significant diminution in HCRT contents of cerebrospinal fluid. In order to study narcolepsy, several experimental models have been developed. Murine and canine models currently allow us to study this disease. Our laboratory has developed a new experimental rat model of narcolepsy. This model allows us to study the disease from a histological and neurochemical perspective. Elsewhere we have reported that the use of the toxin hypocretin2/saporine (HCRT2/ SAP) selectively destroys hypocretinergic neurons. The loss of these neurons induces a similar behavioural profile as the one observed in other experimental models of narcolepsy. In the present review we describe an overview on narcolepsy, the hypocretinergic system, experimental models in narcolepsy and the use of transplants as an alternative therapeutic tool.
Assuntos
Humanos , Animais , Narcolepsia/etiologia , Neuropeptídeos/fisiologia , Peptídeos e Proteínas de Sinalização Intracelular/fisiologiaRESUMO
Narcolepsy is a chronic disease characterized by excessive somnolence, abrupt transitions from wakefulness to rapid eye movement sleep stage and cataplexy. Experimental evidence show that narcolepsy in humans is a neurodegenerative disease associated with the lost of hypocretin (HCRT) neurons in the lateral hypothalamus. Narcoleptic patients also display a significant diminution in HCRT contents of cerebrospinal fluid. In order to study narcolepsy, several experimental models have been developed. Murine and canine models currently allow us to study this disease. Our laboratory has developed a new experimental rat model of narcolepsy. This model allows us to study the disease from a histological and neurochemical perspective. Elsewhere we have reported that the use of the toxin hypocretin2/saporine (HCRT2/ SAP) selectively destroys hypocretinergic neurons. The loss of these neurons induces a similar behavioural profile as the one observed in other experimental models of narcolepsy. In the present review we describe an overview on narcolepsy, the hypocretinergic system, experimental models in narcolepsy and the use of transplants as an alternative therapeutic tool.