| Title | CSF hypocretin-1 assessment in sleep and neurological disorders. | | Author(s) | Bourgin P, Zeitzer JM, Mignot E | | Institution | Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA; Department of Biological Sciences, Stanford University, Stanford, CA, USA; Department of Neurology, School of Medicine, and Laboratory of Rhythms, CNRS UMR 7168/LC2, Louis Pasteur University, Strasbourg, France. | | Source | Lancet Neurol 2008 Jul; 7(7):649-662. | | Abstract | Concentrations of CSF hypocretin-1 (formerly orexin A) have been measured in many patients with sleep or neurological conditions. Low CSF hypocretin-1 is most predictive of narcolepsy in patients positive for HLA allele DQB1*0602, most of whom have cataplexy. By contrast, the diagnostic significance of low CSF hypocretin-1 is unclear in the presence of acute CNS inflammation or trauma. The clinical usefulness of CSF testing in hypersomnia that is symptomatic of a neurological disorder remains to be evaluated. Determination of CSF hypocretin-1 concentration to diagnose narcolepsy might be most useful in ambulatory patients with cataplexy but with a normal multiple sleep latency test (MSLT) result, or if MSLT is not interpretable, conclusive, or feasible. Because 98% of patients with hypocretin-1 deficiency are positive for HLA DQB1*0602, we suggest that HLA typing is a useful screen before lumbar puncture. Although hypocretin-1 deficiency in narcolepsy might have therapeutic relevance, additional research is needed in this area. | | Language | ENG | | Pub Type(s) | JOURNAL ARTICLE
| | PubMed ID | 18565458 |
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