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Narkolepsie

Narcolepsy

Zusammenfassung

Die Narkolepsie ist eine seltene Erkrankung. Die klassische Form umfasst die 4 Symptome exzessive Tagesmüdigkeit, Kataplexie, Schlaflähmung (Schlafparalyse) und hypnagoge Halluzinationen. Als Modellerkrankung nimmt sie in der Neurologie und Schlafmedizin eine bedeutende Rolle ein, da sie alle Übergänge vom Wach- in die Schlafzustände, Non-REM und REM aufweist. Bei Narkolepsiepatienten findet sich eine verringerte Zahl von hypokretinproduzierenden Neuronen im Hypothalamus und entsprechend ist der Hypokretinspiegel im Liquor erniedrigt. Das Neuropeptid Hypokretin (Orexin) besitzt Steuerfunktionen des Schlaf-Wach-Zyklus, der Regulation des autonomen Nervensystems, der Motorik und der metabolischen Prozesse. Dass die Narkolepsie noch immer zu spät diagnostiziert wird, ist in der modernen Medizin kaum nachvollziehbar. Möglicherweise ist die hohe Assoziation mit anderen Schlaf-Wach-Störungen hierfür verantwortlich. Genomweite Analysen konnten zeigen, dass Autoimmunmechanismen wesentlich an der Entstehung der Narkolepsie beteiligt sind. Hiervon sind die HLA-Assoziation mit inzwischen bekannten Allelen für Suszeptibilität und Protektion von allen bisher beschriebenen Assoziationen am wichtigsten. Bildgebende Verfahren zeigen auch neurodegenerative Veränderungen, sodass weiterhin eine multifaktorielle Ätiopathogenese wahrscheinlich ist. Das häufige Auftreten metabolischer Störungen ist noch nicht hinreichend geklärt. Die Früherkennung der Narkolepsie birgt neben den Möglichkeiten, den Betroffenen durch angemessene Therapie ein fast normales Leben zu ermöglichen, auch die Option einer immunmodulierenden Therapie, mit der Chance die Narkolepsie zu heilen.

Summary

Narcolepsy is a rare sleep disorder. The classical presentation includes the four symptoms excessive daytime sleepiness, cataplexy, sleep paralysis and hypnagogic hallucinations. As a model disease with all the transitions from awake to sleeping conditions, non-rapid eye movement (NREM) and rapid eye movement (REM), it plays an important role in neurology and sleep medicine. Patients with narcolepsy possess a reduced number of hypocretin-producing neurons in the hypothalamus and accordingly the hypocretin level in the cerebrospinal fluid is low. The neuropeptide hypocretin (orexin) has functions, such as the regulation of the sleep-wake cycle, the autonomous nerve system, motor system and metabolic processes. The delay in diagnosing narcolepsy is difficult to comprehend in modern medicine. The frequent association with other sleep-wake disorders may be responsible for the delay. Genomewide association studies have subsequently been able to prove that autoimmune mechanisms are responsible for the manifestation of narcolepsy with the HLA association being the most important for susceptibility and protection. Imaging studies have revealed neurodegenerative changes, making a multifactorial etiopathogenesis probable. The frequent occurrence of metabolic disorders has not yet been clarified. Early diagnosis of narcolepsy has the possibility to offer affected persons an adequate medication to lead an almost normal life and the future possibility to cure narcolepsy through immunomodulation therapy.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. G. Mayer gibt an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Mayer, G. Narkolepsie. Nervenarzt 85, 26–34 (2014). https://doi.org/10.1007/s00115-013-3889-2

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Schlüsselwörter

  • Narkolepsie
  • Kataplexie
  • Hypokretin
  • HLA
  • Immunmodulierende Therapie

Keywords

  • Narcolepsy
  • Cataplexy
  • Hypocretin
  • HLA
  • Immunomodulating therapy