A perspective on narcolepsy

Neurochemical analyses were performed on brains obtained at post mortem from 3 patients with narcolepsy. The salient findings were an increase in noradrenergic and serotonergic neuronal activity, a decrease in dopaminergic neuronal activity, and, in 2 of the 3 brains, a decrease in the number of alpha-1-noradrenergic receptors in the frontal cortex and amygdala. A pathophysiological model for narcolepsy is developed on the basis of these findings. The neurobiology of narcolepsy is compared with that of depression. The role of MHC--class II gene products in the genesis of narcolepsy is discussed. Some treatment implications follow.