CSF hypocretin-1 assessment in sleep and neurological disorders.
Article Details
- CitationCopy to clipboard
Bourgin P, Zeitzer JM, Mignot E
CSF hypocretin-1 assessment in sleep and neurological disorders.
Lancet Neurol. 2008 Jul;7(7):649-62. doi: 10.1016/S1474-4422(08)70140-6.
- PubMed ID
- 18565458 [ View in PubMed]
- 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.