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Hypocretin (orexin) and melatonin values in a narcoleptic-like sleep disorder after pinealectomy

Lois E Krahn1, Bradley F Boeve, Lawrence Oliver

  • 1Mayo Sleep Disorder Center, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905, USA. krahn.lois@mayo.edu

Sleep Medicine
|November 1, 2003
PubMed

Insights

A patient developed narcolepsy-like symptoms after cancer treatment. This case highlights a hypocretin-independent mechanism for narcolepsy, distinct from typical causes.

Area of Science:

  • Neurology
  • Sleep Medicine
  • Neuro-oncology

Background:

  • Narcolepsy is often linked to hypocretin (orexin) deficiency.
  • Secondary narcolepsy can arise from other neurological conditions.

Purpose of the Study:

  • To present a case of narcolepsy-like disorder following treatment for a pineal gland tumor.
  • To investigate the underlying mechanism of narcolepsy in this specific patient, considering treatments received.

Main Methods:

  • Detailed clinical observation of a patient with excessive daytime sleepiness, sleep paralysis, and hypnagogic hallucinations.
  • Multiple sleep latency test (MSLT) to assess sleep patterns, including REM sleep.
  • Analysis of cerebrospinal fluid for hypocretin levels.
  • Human leukocyte antigen (HLA) typing (DQB1*0602).

Main Results:

  • The patient exhibited narcolepsy-like symptoms after pinealectomy, chemotherapy, and radiation for choroid plexus carcinoma.
  • MSLT revealed increased REM sleep percentage and sleep onset REM periods.
  • Preserved circadian rhythmicity for melatonin and cortisol.
  • The patient was HLA-DQB1*0602 negative with detectable cerebrospinal fluid hypocretin levels (518 pg/ml).

Conclusions:

  • The narcolepsy-like disorder was likely induced by surgical intervention or radiation therapy for the pineal tumor.
  • This case suggests a hypocretin-independent mechanism for narcolepsy, differing from typical autoimmune or genetic causes.
  • Further research is warranted to elucidate the novel mechanism responsible for these symptoms.

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