Hypocretin (orexin) and melatonin values in a narcoleptic-like sleep disorder after pinealectomy.
Lois E Krahn, Bradley F Boeve, Lawrence Oliver, Michael H. Silber
Sleep Medicine November 2002 DOI: 10.1016/s1389-9457(02)00068-0 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Case study Case report Peer reviewed |
|---|---|
| Sample size | 1 |
| Population | A woman with a choroid plexus carcinoma of the pineal gland treated with pinealectomy, chemotherapy, and radiation |
| Measures | multiple sleep latency test |
| Key findings | The authors report that a narcolepsy-like disorder with excessive daytime sleepiness, sleep paralysis, hypnagogic hallucinations, increased REM sleep, and sleep-onset REM periods followed treatment for a pineal gland tumor. Because the patient was HLA DQB1*0602 negative and had a detectable CSF hypocretin level (518 pg/ml), they argue the symptoms likely arose from surgery or radiation through a mechanism unrelated to hypocretin depletion. |
Abstract
Narcolepsy secondary to other neurologic processes has been recently associated with hypocretin (orexin) deficiency. We present a patient who developed a narcoleptic-like sleep disorder after receiving treatment for a choroid plexus carcinoma of the pineal gland. She underwent a pinealectomy, chemotherapy, and radiation treatment. The primary features of this condition were excessive daytime sleepiness, sleep paralysis and hypnagogic hallucinations. Increased percentage of rapid eye movement (REM) sleep and sleep onset REM periods were seen during the multiple sleep latency test. Circadian rhythmicity was preserved for melatonin and cortisol. She was negative for human leukocyte antigen DQB1*0602 and had a detectable cerebrospinal fluid hypocretin level (518 pg/ml). We emphasize that the narcoleptic-like disorder likely resulted from the surgical intervention or radiation therapy. Her symptoms are caused by an unknown mechanism unrelated to hypocretin depletion which merits more research.