Abstract
In narcolepsy–cataplexy (NC) patients, cataplexy attacks (sudden loss of muscle tone) are most often triggered by strong emotional experiences, in particular positive emotions such as laughter or joking. While muscle atonia associated with cataplexy is thought to implicate ponto-medullary mechanisms, the suprapontine brain mechanisms associated with the cataplectic effects of emotions in human NC remain essentially unknown. Recent animal data suggest that the hypocretin (Hcrt; also called orexin) system, which is deficient in NC patients, is involved not only in the regulation of sleep–wake states but also in emotional and reward processes. Emotion-triggered cataplexy could thus represent an affective consequence of Hcrt deficiency in human NC. In this chapter, we present evidence suggesting that the Hcrt system may play a key modulating role in hypothalamic-limbic circuits that are involved in the integration of emotion, reward, and sleep processes. We show that this hypothesis can be successfully tested using modern functional brain imaging techniques in NC patients. We report recent functional magnetic resonance imaging (fMRI) results showing that humorous pictures elicit reduced hypothalamic response together with enhanced amygdala response in NC patients. We also discuss the implications of these recent findings for current models of cataplexy.
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Notes
- 1.
The H-reflex or Hoffmann reflex relies on the contraction of the flexors of the calf, monosynaptically activated following excitation of sensory nerve fibers in the tibial nerve. Its amplitude, measured electromyographically, reflects interneuron modulation of motor-neuron excitability, and diminishes when inhibitory interneurons are excited. The H-reflex strongly decreases during cataplexy episodes triggered by amusement in NC patients [25, 35]. It is decreased during NREM sleep and abolished during REM sleep [36].
References
Bassetti, C. & Aldrich, M.S. Narcolepsy. Neurol Clin 14, 545–571 (1996)
de Lecea, L. et al. The hypocretins: hypothalamus-specific peptides with neuroexcitatory activity. Proc Natl Acad Sci U S A 95, 322–327 (1998)
Peyron, C. et al. A mutation in a case of early onset narcolepsy and a generalized absence of hypocretin peptides in human narcoleptic brains. Nat Med 6, 991–997 (2000)
Sakurai, T. et al. Orexins and orexin receptors: a family of hypothalamic neuropeptides and G protein-coupled receptors that regulate feeding behavior. Cell 92, 573–585 (1998)
Thannickal, T.C. et al. Reduced number of hypocretin neurons in human narcolepsy. Neuron 27, 469–474 (2000)
Thannickal, T.C., Siegel, J.M., Nienhuis, R. & Moore, R.Y. Pattern of hypocretin (orexin) soma and axon loss, and gliosis, in human narcolepsy. Brain Pathol 13, 340–351 (2003)
Nishino, S. & Mignot, E. Pharmacological aspects of human and canine narcolepsy. Prog Neurobiol 52, 27–78 (1997)
Adamantidis, A.R., Zhang, F., Aravanis, A.M., Deisseroth, K. & de Lecea, L. Neural substrates of awakening probed with optogenetic control of hypocretin neurons. Nature 450, 420–424 (2007)
Saper, C.B., Scammell, T.E. & Lu, J. Hypothalamic regulation of sleep and circadian rhythms. Nature 437, 1257–1263 (2005)
Baumann, C.R. & Bassetti, C.L. Hypocretins (orexins) and sleep-wake disorders. Lancet Neurol 4, 673–682 (2005)
Sakurai, T. The neural circuit of orexin (hypocretin): maintaining sleep and wakefulness. Nat Rev Neurosci 8, 171–181 (2007)
Akbari, E., Motamedi, F., Naghdi, N. & Noorbakhshnia, M. The effect of antagonization of orexin 1 receptors in CA1 and dentate gyrus regions on memory processing in passive avoidance task. Behav Brain Res 187, 172–177 (2008)
Narita, M. et al. Direct involvement of orexinergic systems in the activation of the mesolimbic dopamine pathway and related behaviors induced by morphine. J Neurosci 26, 398–405 (2006)
Borgland, S.L., Taha, S.A., Sarti, F., Fields, H.L. & Bonci, A. Orexin A in the VTA is critical for the induction of synaptic plasticity and behavioral sensitization to cocaine. Neuron 49, 589–601 (2006)
Harris, G.C., Wimmer, M. & Aston-Jones, G. A role for lateral hypothalamic orexin neurons in reward seeking. Nature 437, 556–559 (2005)
Boutrel, B. et al. Role for hypocretin in mediating stress-induced reinstatement of cocaine-seeking behavior. Proc Natl Acad Sci U S A 102, 19168–19173 (2005)
Ohno, K. & Sakurai, T. Orexin neuronal circuitry: role in the regulation of sleep and wakefulness. Front Neuroendocrinol 29, 70–87 (2008)
Mignot, E. et al. The role of cerebrospinal fluid hypocretin measurement in the diagnosis of narcolepsy and other hypersomnias. Arch Neurol 59, 1553–1562 (2002)
Chemelli, R.M. et al. Narcolepsy in orexin knockout mice: molecular genetics of sleep regulation. Cell 98, 437–451 (1999)
Lin, L. et al. The sleep disorder canine narcolepsy is caused by a mutation in the hypocretin (orexin) receptor 2 gene. Cell 98, 365–376 (1999)
Mattarozzi, K. et al. Clinical, behavioural and polysomnographic correlates of cataplexy in patients with narcolepsy/cataplexy. Sleep Med 9, 425–433 (2008)
Sturzenegger, C. & Bassetti, C.L. The clinical spectrum of narcolepsy with cataplexy: a reappraisal. J Sleep Res 13, 395–406 (2004)
Anic-Labat, S. et al. Validation of a cataplexy questionnaire in 983 sleep-disorders patients. Sleep 22, 77–87 (1999)
Mignot, E., Hayduk, R., Black, J., Grumet, F.C. & Guilleminault, C. HLA DQB1*0602 is associated with cataplexy in 509 narcoleptic patients. Sleep 20, 1012–1020 (1997)
Guilleminault, C. & Gelb, M. Clinical aspects and features of cataplexy. Adv Neurol 67, 65–77 (1995)
Overeem, S., Mignot, E., van Dijk, J.G. & Lammers, G.J. Narcolepsy: clinical features, new pathophysiologic insights, and future perspectives. J Clin Neurophysiol 18, 78–105 (2001)
Gelb, M. et al. Stability of cataplexy over several months – information for the design of therapeutic trials. Sleep 17, 265–273 (1994)
Guilleminault, C., Wilson, R.A. & Dement, W.C. A study on cataplexy. Arch Neurol 31, 255–261 (1974)
Nishino, S., Tafti, M., Sampathkumaran, R., Dement, W.C. & Mignot, E. Circadian distribution of rest/activity in narcoleptic and control dogs: assessment with ambulatory activity monitoring. J Sleep Res 6, 120–127 (1997)
Nishino, S., Reid, M.S., Dement, W.C. & Mignot, E. Neurop-harmacology and neurochemistry of canine narcolepsy. Sleep 17, S84–S92 (1994)
Espana, R.A., McCormack, S.L., Mochizuki, T. & Scammell, T.E. Running promotes wakefulness and increases cataplexy in orexin knockout mice. Sleep 30, 1417–1425 (2007)
Overeem, S., Lammers, G.J. & van Dijk, J.G. Weak with laughter. Lancet 354, 838 (1999)
Lammers, G.J., Overeem, S., Tijssen, M.A. & van Dijk, J.G. Effects of startle and laughter in cataplectic subjects: a neurophysiological study between attacks. Clin Neurophysiol 111, 1276–1281 (2000)
Overeem, S., Reijntjes, R., Huyser, W., Lammers, G.J. & van Dijk, J.G. Corticospinal excitability during laughter: implications for cataplexy and the comparison with REM sleep atonia. J Sleep Res 13, 257–264 (2004)
Hishikawa, Y. & Shimizu, T. Physiology of REM sleep, cataplexy, and sleep paralysis. Adv Neurol 67, 245–271 (1995)
Sandrini, G. et al. Effects of sleep on spinal nociceptive reflexes in humans. Sleep 24, 13–17 (2001)
Tucci, V. et al. Emotional information processing in patients with narcolepsy: a psychophysiologic investigation. Sleep 26, 558–564 (2003)
Khatami, R., Birkmann, S. & Bassetti, C.L. Amygdala dysfunction in narcolepsy-cataplexy. J Sleep Res 16, 226–229 (2007)
Vrana, S.R., Spence, E.L. & Lang, P.J. The startle probe response: a new measure of emotion? J Abnorm Psychol 97, 487–491 (1988)
Siegel, J.M. et al. Neuronal degeneration in canine narcolepsy. J Neurosci 19, 248–257 (1999)
Gulyani, S., Wu, M.F., Nienhuis, R., John, J. & Siegel, J.M. Cataplexy-related neurons in the amygdala of the narcoleptic dog. Neuroscience 112, 355–365 (2002)
Schwartz, S. et al. Abnormal activity in hypothalamus and amygdala during humour processing in human narcolepsy with cataplexy. Brain 131, 514–522 (2008)
Desseilles, M. et al. Neuroimaging insights into the pathophysiology of sleep disorders. Sleep 31, 777–794 (2008)
Overeem, S. et al. Voxel-based morphometry in hypocretin-deficient narcolepsy. Sleep 26, 44–46 (2003)
Brenneis, C. et al. Voxel-based morphometry in narcolepsy. Sleep Med 6, 531–536 (2005)
Kaufmann, C., Schuld, A., Pollmacher, T. & Auer, D.P. Reduced cortical gray matter in narcolepsy: preliminary findings with voxel-based morphometry. Neurology 58, 1852–1855 (2002)
Draganski, B. et al. Hypothalamic gray matter changes in narcoleptic patients. Nat Med 8, 1186–1188 (2002)
Buskova, J., Vaneckova, M., Sonka, K., Seidl, Z. & Nevsimalova, S. Reduced hypothalamic gray matter in narcolepsy with cataplexy. Neuro Endocrinol Lett 27, 769–772 (2006)
Lodi, R. et al. In vivo evidence of neuronal loss in the hypothalamus of narcoleptic patients. Neurology 63, 1513–1515 (2004)
Ellis, C.M., Simmons, A., Lemmens, G., Williams, S.C. & Parkes, J.D. Proton spectroscopy in the narcoleptic syndrome. Is there evidence of a brainstem lesion? Neurology 50, S23–S26 (1998)
De Stefano, N., Matthews, P.M. & Arnold, D.L. Reversible decreases in N-acetylaspartate after acute brain injury. Magn Reson Med 34, 721–727 (1995)
Nishino, S. & Kanbayashi, T. Symptomatic narcolepsy, cataplexy and hypersomnia, and their implications in the hypothalamic hypocretin/orexin system. Sleep Med Rev 9, 269–310 (2005)
Joo, E.Y., Tae, W.S., Kim, J.H., Kim, B.T. & Hong, S.B. Glucose hypometabolism of hypothalamus and thalamus in narcolepsy. Ann Neurol 56, 437–440 (2004)
Joo, E.Y. et al. Cerebral perfusion abnormality in narcolepsy with cataplexy. Neuroimage 28, 410–416 (2005)
Hong, S.B., Tae, W.S. & Joo, E.Y. Cerebral perfusion changes during cataplexy in narcolepsy patients. Neurology 66, 1747–1749 (2006)
Chabas, D. et al. Functional imaging of cataplexy during status cataplecticus. Sleep 30, 153–156 (2007)
Ellis, C.M. et al. Functional magnetic resonance imaging neuroactivation studies in normal subjects and subjects with the narcoleptic syndrome. Actions of modafinil. J Sleep Res 8, 85–93 (1999)
Wild, B., Rodden, F.A., Grodd, W. & Ruch, W. Neural correlates of laughter and humour. Brain 126, 2121–2138 (2003)
Arroyo, S. et al. Mirth, laughter and gelastic seizures. Brain 116(4), 757–780 (1993)
Kuzniecky, R.I. et al. Multimodality MRI in mesial temporal sclerosis: relative sensitivity and specificity. Neurology 49, 774–778 (1997)
Wild, B., Erb, M., Eyb, M., Bartels, M. & Grodd, W. Why are smiles contagious? An fMRI study of the interaction between perception of facial affect and facial movements. Psychiatry Res 123, 17–36 (2003)
Goel, V. & Dolan, R.J. The functional anatomy of humor: segregating cognitive and affective components. Nat Neurosci 4, 237–238 (2001)
Moran, J.M., Wig, G.S., Adams, R.B., Jr., Janata, P. & Kelley, W.M. Neural correlates of humor detection and appreciation. Neuroimage 21, 1055–1060 (2004)
Mobbs, D., Greicius, M.D., Abdel-Azim, E., Menon, V. & Reiss, A.L. Humor modulates the mesolimbic reward centers. Neuron 40, 1041–1048 (2003)
O’Doherty, J.P., Buchanan, T.W., Seymour, B. & Dolan, R.J. Predictive neural coding of reward preference involves dissociable responses in human ventral midbrain and ventral striatum. Neuron 49, 157–166 (2006)
Watson, K.K., Matthews, B.J. & Allman, J.M. Brain activation during sight gags and language-dependent humor. Cereb Cortex 17, 314–324 (2007)
Critchley, H.D., Mathias, C.J. & Dolan, R.J. Neural activity in the human brain relating to uncertainty and arousal during anticipation. Neuron 29, 537–545 (2001)
Reiss, A.L. et al. Anomalous hypothalamic responses to humor in cataplexy. PLoS ONE 3, e2225 (2008)
Sullivan, G.M. et al. Lesions in the bed nucleus of the stria terminalis disrupt corticosterone and freezing responses elicited by a contextual but not by a specific cue-conditioned fear stimulus. Neuroscience 128, 7–14 (2004)
Price, J.L. Free will versus survival: brain systems that underlie intrinsic constraints on behavior. J Comp Neurol 493, 132–139 (2005)
LeDoux, J.E. Emotion circuits in the brain. Annu Rev Neurosci 23, 155–184 (2000)
Bisetti, A. et al. Excitatory action of hypocretin/orexin on neurons of the central medial amygdala. Neuroscience 142, 999–1004 (2006)
Marcus, J.N. et al. Differential expression of orexin receptors 1 and 2 in the rat brain. J Comp Neurol 435, 6–25 (2001)
Date, Y. et al. Orexins, orexigenic hypothalamic peptides, interact with autonomic, neuroendocrine and neuroregulatory systems. Proc Natl Acad Sci U S A 96, 748–753 (1999)
Fadel, J. & Deutch, A.Y. Anatomical substrates of orexin–dopamine interactions: lateral hypothalamic projections to the ventral tegmental area. Neuroscience 111, 379–387 (2002)
Vittoz, N.M. & Berridge, C.W. Hypocretin/orexin selectively increases dopamine efflux within the prefrontal cortex: involvement of the ventral tegmental area. Neuropsychopharmacology 31, 384–395 (2006)
Hariri, A.R., Mattay, V.S., Tessitore, A., Fera, F. & Weinberger, D.R. Neocortical modulation of the amygdala response to fearful stimuli. Biol Psychiatry 53, 494–501 (2003)
Milad, M.R. & Quirk, G.J. Neurons in medial prefrontal cortex signal memory for fear extinction. Nature 420, 70–74 (2002)
Phelps, E.A., Delgado, M.R., Nearing, K.I. & LeDoux, J.E. Extinction learning in humans: role of the amygdala and vmPFC. Neuron 43, 897–905 (2004)
Georgescu, D. et al. Involvement of the lateral hypothalamic peptide orexin in morphine dependence and withdrawal. J Neurosci 23, 3106–3111 (2003)
Parkes, J.D., Baraitser, M., Marsden, C.D. & Asselman, P. Natural history, symptoms and treatment of the narcoleptic syndrome. Acta Neurol Scand 52, 337–353 (1975)
Schwartz, S. et al. Emotional and motor responses during game playing in narcoleptic patients: a functional MRI study. J Sleep Res 15, 32 (2006)
Overeem, S., Lammers, G.J. & van Dijk, J.G. Cataplexy: ‘tonic immobility’ rather than ‘REM-sleep atonia’? Sleep Med 3, 471–477 (2002)
Talarovicova, A., Krskova, L. & Kiss, A. Some assessments of the amygdala role in suprahypothalamic neuroendocrine regulation: a minireview. Endocr Regul 41, 155–162 (2007)
Misslin, R. The defense system of fear: behavior and neurocircuitry. Neurophysiol Clin 33, 55–66 (2003)
Phan, K.L., Wager, T., Taylor, S.F. & Liberzon, I. Functional neuroanatomy of emotion: a meta-analysis of emotion activation studies in PET and fMRI. Neuroimage 16, 331–348 (2002)
LeDoux, J. The emotional brain, fear, and the amygdala. Cell Mol Neurobiol 23, 727–738 (2003)
Bassetti, C. Cataplexy: ‘REM-atonia or tonic immobility’? Sleep Med 3, 465–466 (2002)
Kayaba, Y. et al. Attenuated defense response and low basal blood pressure in orexin knockout mice. Am J Physiol Regul Integr Comp Physiol 285, R581–R593 (2003)
Zhang, W., Sakurai, T., Fukuda, Y. & Kuwaki, T. Orexin neuron-mediated skeletal muscle vasodilation and shift of baroreflex during defense response in mice. Am J Physiol Regul Integr Comp Physiol 290, R1654–R1663 (2006)
Winsky-Sommerer, R. et al. Interaction between the corticotropin-releasing factor system and hypocretins (orexins): a novel circuit mediating stress response. J Neurosci 24, 11439–11448 (2004)
Winsky-Sommerer, R., Boutrel, B. & de Lecea, L. Stress and arousal: the corticotrophin-releasing factor/hypocretin circuitry. Mol Neurobiol 32, 285–294 (2005)
Fuse, T., Forsyth, J.P., Marx, B., Gallup, G.G. & Weaver, S. Factor structure of the Tonic Immobility Scale in female sexual assault survivors: an exploratory and Confirmatory Factor Analysis. J Anxiety Disord 21, 265–283 (2007)
Maquet, P. et al. Functional neuroanatomy of human rapid-eye-movement sleep and dreaming. Nature 383, 163–166 (1996)
Acknowledgments
This work was supported by grants from the Swiss National Science Foundation (# 3200B0-104100, # 3100A0-102133), by the National Centre of Competence in Research (NCCR) Affective sciences financed by the Swiss National Science Foundation (# 51NF40-104897), and the Geneva Center for Neurosciences.
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Ponz, A., Schwartz, S. (2010). Humor Processing in Human Narcolepsy with Cataplexy. In: Goswami, M., Pandi-Perumal, S., Thorpy, M. (eds) Narcolepsy. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-0854-4_11
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