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Related Experiment Video

Updated: May 31, 2026

Induction of Paralysis and Visual System Injury in Mice by T Cells Specific for Neuromyelitis Optica Autoantigen Aquaporin-4

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Hypocretinergic dysfunction in neuromyelitis optica with coma-like episodes.

B Carlander¹, T Vincent, A Le Floch

¹Department of Neurology, Hôpital Gui-de-Chauliac, Montpellier, France.

BMJ Case Reports

|June 21, 2011

Summary

Devic's neuromyelitis optica (NMO), a CNS demyelinating disease, can present with severe dysautonomia and hypersomnia. A case study revealed a significant drop in hypocretin/orexin levels in cerebrospinal fluid during NMO relapses.

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Published on: November 23, 2013

Area of Science:

Neuroimmunology
Neurology
Sleep Medicine

Background:

Devic's neuromyelitis optica (NMO) is a severe autoimmune demyelinating disease targeting the central nervous system (CNS).
NMO primarily affects the optic nerves and spinal cord, and is often misdiagnosed as multiple sclerosis.
Dysautonomia and hypersomnia are less common but significant symptoms that can occur in NMO patients.

Purpose of the Study:

To report a unique case of relapsing NMO with severe dysautonomia and hypersomnia.
To investigate the association between NMO relapses and hypocretin/orexin levels in cerebrospinal fluid (CSF).

Main Methods:

Case report detailing clinical presentation, diagnostic workup, and treatment of a patient with relapsing NMO.
Cerebrospinal fluid (CSF) analysis including hypocretin/orexin level measurement.

Main Results:

The patient experienced recurrent episodes of severe dysautonomia and hypersomnia coinciding with NMO relapses.
A dramatic decrease in CSF hypocretin/orexin levels was observed during these relapses.
Hypocretin/orexin levels showed partial recovery between relapses.

Conclusions:

This case suggests a potential link between hypocretin/orexin system dysfunction and NMO relapses, particularly those involving severe dysautonomia and hypersomnia.
Further research is warranted to explore the role of hypocretin/orexin in the pathophysiology of NMO.
Monitoring hypocretin/orexin levels may offer insights into NMO disease activity and management.