Hypersomnia and Low CSF Hypocretin-1 (Orexin-A) Concentration in a Patient with Multiple Sclerosis Showing Bilateral Hypothalamic Lesions

• Published in: Internal Medicine Vol. 42; no. 8; pp. 743 - 745
• Main Authors: NAKANO, Takeshi, KANBAYASHI, Takashi, SfflMIZU, Tetsuo, HASHIMOTO, Takao, KATO, Takashi, IKEDA, Shu-ichi, YAMAMOTO, Kanji
• Format: Journal Article
• Language: English
• Published: Tokyo The Japanese Society of Internal Medicine 01.08.2003; Japanese Society of Internal Medicine
• Subjects: Anti-Inflammatory Agents - administration & dosage; Biological and medical sciences; Carrier Proteins - cerebrospinal fluid; Cerebrospinal Fluid - chemistry; Disorders of Excessive Somnolence - cerebrospinal fluid; Disorders of Excessive Somnolence - drug therapy; Disorders of Excessive Somnolence - etiology; Disorders of Excessive Somnolence - metabolism; Female; Humans; hypersomnia; hypocrein; Hypothalamic Diseases - diagnosis; Hypothalamic Diseases - drug therapy; Hypothalamic Diseases - etiology; Hypothalamic Diseases - metabolism; hypothalamus; Intracellular Signaling Peptides and Proteins; Magnetic Resonance Imaging; Medical sciences; Methylprednisolone - administration & dosage; Middle Aged; multiple sclerosis; Multiple Sclerosis - cerebrospinal fluid; Multiple Sclerosis - complications; Multiple Sclerosis - drug therapy; Multiple sclerosis and variants. Guillain barré syndrome and other inflammatory polyneuropathies. Leukoencephalitis; Neurology; Neuropeptides - cerebrospinal fluid; orexin; Orexins; Pulse Therapy, Drug; Treatment Outcome; Human; Nervous system diseases; Hypersomnia; Multiple sclerosis; Radiodiagnosis; Hypothalamic diseases; Bilateral; Hypothalamus; Cerebrospinal fluid; hypocrein; Neuropeptide; Inflammatory disease; Case study; Low; Central nervous system disease; Medical imagery; Complication; Female; Computerized axial tomography; Lesion; Orexin
• ISSN: 0918-2918; 1349-7235
• DOI: 10.2169/internalmedicine.42.743

A 45-year-old Japanese woman with multiple sclerosis (MS) manifested hypersomnia in a relapse of MS. Magnetic resonance imaging revealed new bilateral hypothalamic lesions, and the hypocretin-1 level in the cerebrospinal fluid (CSF) was significantly low. Methylprednisolone pulse treatment successfully resolved the hypersomnia and the left hypothalamic lesion, and it normalized the hypocretin-1 level in the CSF. These findings suggest that the hypothalamic hypocretin (orexin) system may be crucial to maintaining the arousal level and that lesions in the system can cause hypersomnia in MS. (Internal Medicine 42: 743-745, 2003)