Narcolepsy in the pediatric population.
Narcolepsy is characterized by excessive daytime sleepiness, with or without cataplexy. Associated features include sleep paralysis, hypnagogic or hypnopompic hallucinations, and disturbed nocturnal sleep. Narcolepsy is strongly associated with the HLA DQB1*0602 allele, and its symptoms stem from destruction of hypocretin-secreting neurons in the hypothalamus. Recently identified autoantibodies to Tribbles homologue 2 in some patients, as well as cases associated with H1N1 vaccination, support an autoimmune mechanism. There are many challenges in diagnosing and treating pediatric narcolepsy. Caution must also be used in interpreting polysomnography and multiple sleep latency test results in children. HLA testing is nonspecific, and no commercial test exists to measure cerebrospinal fluid hypocretin levels. Neuroimaging has not yet proven useful in primary narcolepsy. Treatment of sleepiness and cataplexy in children requires extrapolating from adult studies. Hopefully, further insights into the pathophysiology of narcolepsy will allow for new therapeutics to manage the symptoms and modify the course of the disease.
Department of Neurology, Children's National Medical Center, 111 Michigan Avenue NW, Washington, DC 20010, USA. eviorrit@childrensnational.org
Erick N
EN
Viorritto
Suraiya A
SA
Kureshi
Judith A
JA
Owens
D000906:Antibodies / Q000097:blood; D017871:Calcium-Calmodulin-Dependent Protein Kinases; D059866:HLA-DQ beta-Chains / Q000235:genetics; D006801:Humans; D007031:Hypothalamus / Q000473:pathology; D047908:Intracellular Signaling Peptides and Proteins / Q000134:cerebrospinal fluid / Q000276:immunology; D009290:Narcolepsy / Q000175:diagnosis / Q000453:epidemiology* / Q000235:genetics / Q000628:therapy*; D059906:Neuroimaging; D009474:Neurons; D009479:Neuropeptides / Q000134:cerebrospinal fluid; D000068797:Orexins; D010372:Pediatrics
D000906:Antibodies; D059866:HLA-DQ beta-Chains; C069051:HLA-DQB1 antigen; D047908:Intracellular Signaling Peptides and Proteins; D009479:Neuropeptides; D000068797:Orexins; D017871:Calcium-Calmodulin-Dependent Protein Kinases; C489044:TRIB2 protein, human