“We are witnessing a revolution of our understanding of narcolepsy.”
– Dr. Emmanuel Mignot, M.D. Ph.D.,
Director of the Center for Sleep Sciences and Medicine, Stanford University
2018 was an exciting year for narcolepsy research and drug development. Here’s my top six research highlights of 2018 that you should know about!
1. Narcolepsy & the immune system
This fall, two new publications offered key insights into the biological underpinnings of type 1 narcolepsy with cataplexy. These findings could lead to new diagnostic procedures and preventive strategies in the future.
In September, Latorre and colleagues’ ground-breaking Nature publication indicated that particular immune cells (called T cells) may be involved in the attack on hypocretin/orexin neurons in type 1 narcolepsy. These findings further the leading theory that narcolepsy may be an “autoimmune condition.” (Here’s a great lay-friendly summary.)
In December, Luo and the Stanford University group’s publication in the Proceedings of the National Academy of Sciences offered interesting complimentary findings, suggesting that these immune cells may mistakingly attack hypocretin/orexin neurons that “resemble” certain pieces of flu virus. The research is more complex and exciting than my brief summary, I recommend Dr. Emmanuel Mignot’s recent Thrive Global article to learn more.
2. Classifying type 2 narcolepsy without cataplexy
Ruoff and colleagues’ Journal of Clinical Sleep Medicine publication raised important awareness about the challenges in classifying and diagnosing type 2 narcolepsy without cataplexy (NT2). The study indicated that repeating the MSLT (the daytime portion of the 24-hour sleep study) led to inconsistent results for narcolepsy type 2 cases, changing to idiophathic hypersomnia 26% of the time, or to a negative MSLT 57% of the time.
This is not a good situation, but researchers are starting to use “big data” and “machine learning” to re-examine how we might better cluster and separate narcolepsy and IH cases by key characteristics and measurements. See Zhang’s Nature publication. Important discussions are underway and I believe this will be an evolving space in the coming years. For those facing a diagnosis “in between NT2 or IH,” please remember your experience is real and you are part …