Sardar Haniyyah, Goldstein-Piekarski Andrea N, Giardino William J
Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States.
Center for Sleep and Circadian Sciences, Stanford University School of Medicine, Stanford, CA, United States.
Front Neurosci. 2023 Apr 21;17:1152594. doi: 10.3389/fnins.2023.1152594. eCollection 2023.
Narcolepsy is a sleep disorder characterized by chronic and excessive daytime sleepiness, and sudden intrusion of sleep during wakefulness that can fall into two categories: type 1 and type 2. Type 1 narcolepsy in humans is widely believed to be caused as a result of loss of neurons in the brain that contain the key arousal neuropeptide Orexin (Orx; also known as Hypocretin). Patients with type 1 narcolepsy often also present with cataplexy, the sudden paralysis of voluntary muscles which is triggered by strong emotions (e.g., laughter in humans, social play in dogs, and chocolate in rodents). The amygdala is a crucial emotion-processing center of the brain; however, little is known about the role of the amygdala in sleep/wake and narcolepsy with cataplexy. A collection of reports across human functional neuroimaging analyses and rodent behavioral paradigms points toward the amygdala as a critical node linking emotional regulation to cataplexy. Here, we review the existing evidence suggesting a functional role for the amygdala network in narcolepsy, and build upon a framework that describes relevant contributions from the central nucleus of the amygdala (CeA), basolateral amygdala (BLA), and the extended amygdala, including the bed nucleus of stria terminalis (BNST). We propose that detailed examinations of amygdala neurocircuitry controlling transitions between emotional arousal states may substantially advance progress in understanding the etiology of narcolepsy with cataplexy, leading to enhanced treatment opportunities.
发作性睡病是一种睡眠障碍，其特征为慢性和过度的日间嗜睡，以及清醒时突然入睡，可分为1型和2型。人们普遍认为，人类1型发作性睡病是由于大脑中含有关键觉醒神经肽食欲素（Orexin，也称为下丘脑分泌素）的神经元丧失所致。1型发作性睡病患者通常还伴有猝倒症，即由强烈情绪（如人类的大笑、狗的社交玩耍和啮齿动物的巧克力）引发的随意肌突然麻痹。杏仁核是大脑中一个关键的情绪处理中心；然而，关于杏仁核在睡眠/觉醒以及伴猝倒症的发作性睡病中的作用，人们所知甚少。一系列涵盖人类功能神经影像学分析和啮齿动物行为范式的报告表明，杏仁核是将情绪调节与猝倒症联系起来的关键节点。在此，我们回顾现有的证据，这些证据表明杏仁核网络在发作性睡病中具有功能性作用，并基于一个描述杏仁核中央核（CeA）、基底外侧杏仁核（BLA）和包括终纹床核（BNST）在内的扩展杏仁核的相关贡献的框架进行阐述。我们提出，详细研究控制情绪唤醒状态之间转换的杏仁核神经回路，可能会极大地推动对伴猝倒症发作性睡病病因的理解，从而增加治疗机会。
