頁籤選單縮合
題 名 | Narcolepsy Update |
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作 者 | Yamada,Thoru; Dyken,Mark E.; | 書刊名 | Acta Neurologica Taiwanica |
卷 期 | 10:4 2001.12[民90.12] |
頁 次 | 頁233-240 |
分類號 | 415.939 |
關鍵詞 | Narcolepsy; Excessive sleepiness; Cataplexy; Sleep paralysis; Hypnagogic hallucination; REM sleep; Hypocretin; LLA; MSLT; |
語 文 | 英文(English) |
英文摘要 | Recent advances in understanding neurochemical and neurophysiological mechanisms of REM sleep have disclosed some mysteries of narcolepsy. Clinical tetrad of sleepiness, cataplexy, hypnagogic hallucination and sleepparalysis can be explained by abnormal intrusion of REM sleep periods into the waking state. In narcolepsy, cholinergic hypersensitivity appears to be responsible to abnormally trigger REM sleep as well as REM sleep atonia. This is evidenced by the local injection of cholinergic agonists into pontine reticular formation triggering REM sleep. Excessive daytime sleepiness is attributable to dopamine hypoactivity at ventral tegmental area and substantia nigra. Correspondingly, the commonly prescribed medication for treatemtn of daytime sleepiness are stimulants which increase dopaminergic transmission by dopamine uptake inhibition or increased dopamine release. Despite well-established role of cholinergic transmission in the regulation of REM sleep, cholinergic compounds are not used for treatment of narcolepsy or cataplexy. Instead, tricyclinic antidepressants are used for treatment of cataplexy; of various neurochemical properties adrenergic uptake inhibition of tricyclin antidepressant are used for treatment of cataplexy; of various neurochemical properties adrenergic uptake inhibition of tricyclic antidepressant at adrenergic system of locus coeruleus appears to have anticataplectic effect. The recent discovery of hypocretin gene deficiency in narcoleptic animals as well as human may lead to new treatment regimen, ie, development of hypocretin agonists which may be effective for narcolepsy treatment. |
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