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Narcolepsy caused by acute disseminated encephalomyelitis
Richard F Gledhill1, Peter R Bartel, Yasushi Yoshida
1Department of Neurology, Medical University of Southern Africa, Ga-Rankuwa Hospital, Pretoria, Republic of South Africa.
Archives of Neurology
|May 19, 2004
Summary
Autoimmune diseases like acute disseminated encephalomyelitis can cause narcolepsy by damaging hypocretin pathways. Steroid treatment partially improved this patient's narcolepsy symptoms and hypocretin deficiency.
Area of Science:
- Neurology
- Immunology
- Sleep Medicine
Background:
- Narcolepsy with cataplexy is typically linked to hypocretin neuron loss.
- Hypothalamic or brainstem lesions can also cause narcolepsy.
Observation:
- A 38-year-old woman presented with severe daytime sleepiness, internuclear ophthalmoplegia, and delayed visual evoked potentials.
- Diagnostic tests revealed short sleep latencies, multiple sleep-onset REM periods, low cerebrospinal fluid hypocretin, and MRI findings consistent with acute disseminated encephalomyelitis.
Findings:
- The patient's narcolepsy symptoms, including sleepiness and hypocretin deficiency, showed partial improvement after steroid treatment.
- This suggests a potential autoimmune etiology for narcolepsy.
Implications:
- Autoimmune conditions such as acute disseminated encephalomyelitis can trigger narcolepsy.
- Narcolepsy may arise from demyelination affecting hypocretin pathways or direct neuronal injury.