The Emotional Pathophysiology Behind Narcolepsy
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Narcolepsy is a chronic debilitating sleep disorder affecting humans and animals, characterized by excessive daytime sleepiness (EDS), cataplexy, hypnagogic hallucinations, and sleep paralysis. It is to be underlined that unlike EDS, that may also occur in other disorders, Cataplexy is a pathognomonic symptom of narcolepsy.

It consists of a sudden drop in muscle tone, total or partial, triggered by intense emotions, especially those leadind to laughters, but also excitement and anger. These attacks can last from a few seconds to a few minutes, during which the patient remains conscious but unable to move.

These symptoms are necessary to diagnose narcolepsy. cataplectic attacks are often triggered by emotions, while frightening contents often characterize sleep paralysis and hallucinations. Also, often the symptoms first appear during the psychologically and sexually turbulent years of adolescence.

The clinical features suggests a close interaction between emotions and related anomalies in NC brain. For instance, neurophysiological evidence revealed a possible involvement of the amygdala in cataplexy. The amygdala is a limbic structure critically involved in emotional information processing in both animals and humans,

A recent functional magnetic resonance imaging (fMRI) study investigated the brain structures whose neural activity is specifically associated with emotion-induced cataplexy. The study showed an increase in blood oxygen level-depend signal in the amygdala during cataplectic attacks. Indirect evidence of amygdala involvement in NC also comes from psychophysiological research.

Several studies showed the involvement of the hypothalamus, considering it as the second main suprapontine brain site whose dysfunction might contribute to cataplexy. Approximately 90% of patients with narcolepsy showed reduced levels of hypocretin in CSF, and postmortem studies confirmed the lack of detectable levels of this peptide in the cortex and the pons, in which normal hypocretinergic projections are found.

Some studies showed that emotional features of dreams are related to the activation of the limbic system. Considering all these findings, the crucial role of emotions in narcolepsy and an impairment of the limbic system in these subjects, the investigation on emotional experience during Mental Sleep Activity for this sleep disorder deserves interest.

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