Hypocretins ( orexins) were identified in 1990s. As many HLA associated disorders are also autoimmune in nature, it raised the possibility that narcolepsy may be an autoimmune disorder. Link with the HLA-DQB1*0602 gene on chromosome 6 was established in 1980s. The first epidemiological studies of narcolepsy were performed by Roth (1980) and Dement (1972-73). Canine narcolepsy in various breeds of dogs was identified in 1973, by Knecht and Mitler. Von Economo first recognized the posterior hypothalamus as a crucial region governing wakefulness. Tumors situated in relation to the third ventricle were suggested as a possible cause of narcolepsy by Wilson. Various causes or lesions were proposed for narcolepsy. Christian Guilleminault at Stanford University in the 1970's helped in establishing this classical hypothesis of dissociated REM sleep in narcolepsy. Further research work by Nathaniel Kleitman at the University of Chicago and William Dement and Dr. Their discovery established a multiple sleep latency test as a standard diagnostic test for narcolepsy in 1970. These authors together first articulated the now classical hypothesis of dissociated REM sleep and explained some symptoms of narcolepsy. Hishikawa (1968) studied the EEG of narcoleptic patients. REM sleep at the onset of sleep attack in narcoleptic patients was first ever recorded and reported by Vogel (1960), an observation extended by Rechschaffen and Dement in 1967. Methylphenidate was introduced by Yoss and Daly in the 1960s. After the discovery of tricyclic antidepressants in 1957, Akimoto, Honda, and Takahashi used imipramine in the treatment of human cataplexy. Various methods were initially proposed in the treatment of narcolepsy until Prinzmetal and Bloomberg introduced amphetamines in 1935. The classic description of narcolepsy tetrad was possible due to further work by Yoss and Daly at the Mayo clinic in 1957 and Bedrich Roth in Prague. Review of narcolepsy- cataplexy by Daniels is considered by many as one of the most insightful clinical reviews published. Kinnier Wilson (1928) first coined the term, " sleep paralysis." Large case series of narcolepsy were reported by Addie (1926), Wilson (1927), and Daniels (1934). Cataplexy from the Greek kataplexis ( fixation of the eyes), was first named by Loëwenfeld (1902). The term narcolepsy is derived by combining the Greek narke numbness, stupor and lepsis attack, to seize. He gave narcolepsy its name, which is the English form of the French word narcolepsie, and also recognized this disorder as a specific clinical entity. French physician Jean-Baptiste-Édouard Gélineau (1880) described this condition in a wine merchant as neurosis or a functional condition. They also observed a hereditary factor the mother of Westphal's patient and a sister of Fisher's patient had similar features. The earliest account of narcolepsy was described by Thomas Willis (1621-1675) in patients, "with a sleepy disposition who suddenly falls fast asleep." The first-ever descriptions of narcolepsy were reported by Westphal (1877) and Fisher (1878) in Germany. Narcolepsy is often under-diagnosed and 5-10 years of delay is common before making a firm diagnosis. It can restrict patients from having certain careers and activities. Problems may include social stigma associated with the disease, reduced quality of life, difficulty in obtaining an education and keeping a job and socioeconomic consequences. Narcolepsy can have severe consequences for the patient with impairments in academic, social and occupational performances. Narcolepsy is of two types: narcolepsy type 1 (formerly narcolepsy with cataplexy) and narcolepsy type 2 (formerly narcolepsy without cataplexy). Other features include frequent irresistible sleep attacks, fragmented night sleep, loss of concentration and memory, hypnopompic hallucinations ( hallucinations during waking up) and blurry vision. Narcolepsy is a debilitating lifelong rapid eye movement ( REM) sleep disorder that has a typical onset during adolescence or early adulthood and is characterized by a classic tetrad of Excessive Daytime Sleepiness ( EDS), cataplexy (sudden symmetric loss of muscle tone during wakefulness that is evoked by strong emotions), sleep paralysis and hypnagogic hallucinations ( hallucinations while falling asleep). Synonyms and keywords: Narcolepsy, Cataplexy, Hypocretin/Orexin, Human Leukocyte Antigen (HLA), Rapid eye movement (REM) sleep, Gamma hydroxybutyrate Associate Editor(s)-in-Chief: Muhammad Waleed Haider, M.D. Template:Search infobox Editor-In-Chief: C. For patient information click here Narcolepsy
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