Graduate Thesis Or Dissertation

 

Narcolepsy : An Interdisciplinary Approach Public Deposited

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  • Narcolepsy is a complex of physiological and behavioral symptoms. The most striking of these are: excessive daytime sleepiness, extremely short latency to rapid eye movement (REM) sleep, hypnogogic hallucinations; sleep paralysis, and cataplexy, which is loss of skeletal muscle tonus in response to intense emotions such as surprise, anger, laughter, competition, or sexual intercourse. What unifies these symptoms is that they are components of the REM phenomenon and narcolepsy has come to be known as REM disorder. The cause(s) of narcolepsy is unknown. A genetic aspect is possibly involved (Carskadon, 1 982; Guilleminault, 1989) and, historically, the pandemic encephalitis lethargica resulted in many reported cases of narcolepsy. Typically, onset of symptoms appear in teenage years although diagnosis usually takes place many years after the actual onset (Navelet, 1 976). There are over 200,000 diagonosed cases in the U.S. (Dement, 1979). Studies using lesions and microelectrode recordings followed by definitive immunohistochemical staining methods have located structures that are possibly involved in the generation of REM components. Pharmacological studies complement the neuroanatomical data by the exogenous induction and suppression of REM and suggest that the cholinergic and catecholaminergic neurotransmitter systems are involved. These same systems are implicated in cognitive behavioral functions of alerting and attention. Narcoleptics have not been extensively studied with cognitive testing, despite the fact that their catecholaminergic and cholinergic systems are impaired as evidenced by the mechanisms of their effective therapies (Mitler, 1986; Soldatos, 1983; Phillips, 1983) and animal studies of receptor number and serum levels of neurotransmitter metabolites (Baker and Dement, 1 985; Kilduff et al., 1986; Faull et a]., 1986). A case study presented in this thesis attempts to assess the ability of a narcoleptic individual to shift covert attention, respond to a warning cue and perform an increasingly difficult response. These tests were given on two different days. On the first day, the subject was using protriptyline, a tn-cyclic antidepressant which potentiates the monoamines and controls cataplexy in the narcoleptic. The second day of testing took place two months after the subject had taken a drug holiday from protriptyline. The results may indicate this individual displays a left hemispheric effect that manifests in difficulty in disengagement, longer reaction times to contralateral targets, and slower motor responses. This case study, suggests future study of cognitive function in the narcolpetic population.
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