392 Index. HPG axis, see Hypothalamic-pituitarygonadal

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1 Index 389 INDEX A Acetylcholine, acetylcholinergic inputs to orexin neurons, 66, 67 brainstem cholinergic nuclei arousal circuits activated by orexins, 144 vigilance control by cholinergic neurons, 182 Actelion orexin receptor antagonists, 354, 355 ACTH, see Adrenocorticotropin Acute disseminated encephalomyelitis (ADEM), orexin levels in cerebrospinal fluid, 306, 307 ADEM, see Acute disseminated encephalomyelitis Adrenocorticotropin (ACTH), narcolepsy patient findings, 336 orexin effects, 124, 125, 134 release patterns in narcolepsy, 321 Agouti-related protein (AgRP), feeding regulation, 101 AgRP, see Agouti-related protein Alzheimer s disease, orexin levels in cerebrospinal fluid, 304 γ-aminobutyric acid (GABA), GABAergic inputs to orexin neurons, 62 neuron release induction by orexin, 52, 53, 55, 57 Amphetamine, narcolepsy management, 227, 371 Appetite, see Feeding behavior Arcuate nucleus, orexin fibers, 24 Arginine vasopressin (AVP), orexin effects, 124, 125 Assays, orexin, antibodies, 74, 75 blood, brain tissue, 80 calcium-mobilizing bioassay, 80 cerebrospinal fluid assay, acute disseminated encephalomyelitis, 306, 307 Alzheimer s disease, 304 applications, brain injury, 304 brain tumors, 297, 298, 300, 301 circadian rhythms and collection sites, dementia with Lewy bodies, 303 extraction, 75, 76 Guillain-Barré syndrome, 307, 308 limbic encephalopathy, 302 multiple sclerosis, myotonic dystrophy, 299, 300 narcolepsy diagnosis, 73, Niemann Pick disease, 299 paraneoplastic syndrome, 308 Parkinson s disease, 303 Prader Willi syndrome, 298, 299 progressive supranuclear palsy, 303 Rasmussen s syndrome, 303 stroke, 301 symptomatic narcolepsy-cataplexy associated with distinct central nervous system lesions, 297, 298 technical considerations, Wernicke s encephalopathy, 302 enzyme immunoassay, 74, 75 immunoblot, 80 neurological disease findings, radioimmunoassay, Atomoxetine, cataplexy management, 227, 371 Autoimmunity, see HLA-DQB1*0602 Autonomic function, orexin, heart rate increase, hypothalamic-pituitary-adrenal axis activation by orexin-a, 111 mean arterial pressure increase, murine narcolepsy models, 264 obesity counterregulation, 114, 115 orexin receptors, 111, 112 paraventricular nucleus, orexin effects on neurons, renal sympathetic nerve activity increase,

2 390 Index AVP, see Arginine vasopressin B Blood, orexin assay, Body weight, see also Feeding behavior, narcolepsy patients, 330, 331 neuroendocrine findings in narcolepsy patients, adrenocorticotropin, 336 clinical significance, 336, 337 corticotrophin-releasing hormone, 336 growth hormone, 333, 335 growth hormone-releasing hormone, 333, 335 leptin, thyroid-releasing hormone, 335, 336 thyroid-stimulating hormone, 335, 336 obesity counterregulation by orexin, 114, 115 orexin and homeostasis, 104 Brain injury, orexin levels in cerebrospinal fluid, 304 symptomatic narcolepsy, 293, 294 Brain tissue, orexin assay, 80 Brain tumors, cataplexy association, 295, 296 narcolepsy association, 293, 294 orexin levels in cerebrospinal fluid, 297, 298, 300, 301 C c-fos, orexin induction, 107, 322 Calcium flux, orexin bioassay, 80 orexin and intracellular calcium increase, 51, 52 Canine narcolepsy, canarc-1 gene, 233, 238 cataplectic attacks, 233, 235 comparison with human and murine narcolepsy, 236, 237, 369 dog leukocyte antigen studies, 237, 238 dopaminergic transmission and electroencephalographic arousal, electroencephalography, 235, genetic transmission, 236 Hcrt-2 gene mutations, 238, 249 monoaminergic and cholinergic interactions in cataplexy control, monoaminergic system imbalance, multiple sleep latency test, 235 orexin levels in sporadic cases, 238, 239 orexin replacement therapy, 248, 249, positional cloning studies, 238 REM sleep disturbances, 235, 240 Stanford Canine Narcolepsy Colony, 233 Carbachol, canine narcolepsy studies, 243 Catechol-O-methyltransferase (COMT), gene polymorphisms in narcolepsy, 281 Cataplexy, see Narcolepsy-cataplexy Cell therapy, narcolepsy treatment prospects, 380, 381 Cerebrospinal fluid (CSF), narcolepsy evaluation, see Narcolepsycataplexy orexin assay, acute disseminated encephalomyelitis, 306, 307 Alzheimer s disease, 304 applications, brain injury, 304 brain tumors, 297, 298, 300, 301 dementia with Lewy bodies, 303 extraction, 75, 76 Guillain-Barré syndrome, 307, 308 limbic encephalopathy, 302 multiple sclerosis, myotonic dystrophy, 299, 300 Niemann-Pick disease, 299 paraneoplastic syndrome, 308 Parkinson s disease, 303 Prader-Willi syndrome, 298, 299 progressive supranuclear palsy, 303 Rasmussen s syndrome, 303 stroke, 301 technical considerations, Wernicke s encephalopathy, 302 orexin tonus changes across sleep/wake cycle, circadian rhythms and collection sites, diurnal animal studies, 161

3 Index 391 manipulations affecting circadian and homeostatic regulation of sleep in rats, sporadic canine narcolepsy orexin levels, 238, 239 Clomipramine, cataplexy management, 227 Coffin-Lowry syndrome, symptomatic cataplexies, 296, 297 COMT, see Catechol-O-methyltransferase Corticotrophin-releasing hormone (CRH), narcolepsy patient findings, 336 orexin effects, 124, 125, 135 release patterns in narcolepsy, 321 CRH, see Corticotrophin-releasing hormone CSF, see Cerebrospinal fluid D Dementia with Lewy bodies, orexin levels in cerebrospinal fluid, 303 Depression, differential diagnosis from narcolepsy, 319, 320 symptoms related to orexin effects, Desipramine, cataplexy management, 227 Dopamine, canine narcolepsy, antagonists in cataplexy control, 242, 243 dopaminergic transmission and electroencephalographic arousal, orexin synergism, 321 vigilance control by dopaminergic neurons, 181 Dorsomedial nucleus of the hypothalamus (DMH), timing of sleep and wakefulness, 196 DSM-IV, neurochemical symptom-syndrome relationship limitations, 318 Dynorphin, narcolepsy postmortem brain studies, 274 orexin neuron expression, 22 E EEG, see Electroencephalography EIA, see Enzyme immunoassay Electroencephalography (EEG), canine narcolepsy, 235, orexin knockout mice, 255, 258, 260 Enzyme immunoassay (EIA), orexin, 74, 75 Exercise, induction of orexin, 210 F Feeding behavior, body weight homeostasis, 104 clinical considerations, 104 fasting and orexin release, 168, 209, 210 mechanisms of orexin-induced feeding, arcuate nucleus role, 101 knockout mouse studies, 102, 103 orexin response in rats, orexin-a and gastric acid secretion, 103 Fluoxetine, cataplexy management, 227, 371 Forebrain, basal forebrain arousal circuits activated by orexins, 145 canine narcolepsy and basal forebrain, 243 orexin receptor expression, 32, 33 Fos, orexin induction of c-fos, 107, 322 sleep-related fluctuations in orexin neurons, 161, 162, 192, 193 G GABA, see γ-aminobutyric acid Galanin, feeding regulation, 102 orexin neuron expression, 22 Gene therapy, narcolepsy treatment prospects, 381 GFAP, see Glial fibrillary acidic protein GH, see Growth hormone GHB, see γ-hydroxybutyric acid Ghrelin, feeding regulation, 104 GHRH, see Growth hormone-releasing hormone Glial fibrillary acidic protein (GFAP), narcolepsy postmortem brain studies, 275 Glutamate, glutamatergic inputs to orexin neurons, 62, 176 Growth hormone (GH), narcolepsy patient findings, 333, 335 release patterns in narcolepsy, 321 suppression by orexin, 126, 127

4 392 Index Growth hormone-releasing hormone (GHRH), narcolepsy patient findings, 333, 335 GTPγS autoradiography, see [ 35 S]GTPγS autoradiography, Guillain-Barré syndrome, orexin levels, 280, 287, 307, 308 H Hcrt-2, canine narcolepsy mutations, 238, 249, 368 Heart rate (HR), orexin effects, Histamine, canine narcolepsy role, 247, 248 feeding behavior and histaminergic neurons, 103 histaminergic inputs to orexin neurons, 67 neuron release induction by orexin, 56 vigilance control by histaminergic neurons, HLA, see Human leukocyte antigen HLA-DQB1*0601, narcolepsy protection, 280 HLA-DQB1*0602, autoimmune basis for narcolepsy, 228, 280, 281, discovery as narcolepsy marker, 221, 223, 270, 341 frequency, 359 peptide binding, 280 prospects for study, 345 related alleles and narcolepsy susceptibility, 223, 270, 342, 343 HPA axis, see Hypothalamic-pituitaryadrenal axis HPG axis, see Hypothalamic-pituitarygonadal axis HR, see Heart rate Human leukocyte antigen (HLA), class II antigens and autoimmune disease, 342 classes, 342 narcolepsy susceptibility, see HLA-DQB1*0602 γ-hydroxybutyric acid (GHB), narcolepsy management, , 370, 371 Hypocretin, see also Orexin, clinical applications, 7, 8 history of study, 3 5, 14 integrative physiology, 5 7 Hypothalamic-pituitary-adrenal (HPA) axis, activation by orexin, 111, arousal circuits activated by orexins, 146 Hypothalamic-pituitary-gonadal (HPG) axis, orexin effects, 120, 121 Hypothalamus, hormone release and orexin regulation, 119 intrahypothalamic network and arousal circuits activated by orexins, 144, 145 orexin fibers, ascending projections, 25, 26, 31, 32 descending projections, 33, 37 integration of sleep/wake behavior with other hypothalamic functions, 197, 198 lateral hypothalamus, 21, 22, 24 orexin receptor expression, OX 1 R, 25, 27, 28 OX 2 R, 25, 29, 30 sleep-promoting systems, 193 timing of sleep and wakefulness, 196, 197 wake-promoting systems, 191 I Imipramine, cataplexy management, 227 Immunoblot, orexin, 80 Interferon-α, gene polymorphisms in narcolepsy, 281 Intravenous immunoglobulin (IVIG), narcolepsy management, 281 IVIG, see Intravenous immunoglobulin K Knockout mice, see Murine narcolepsy models L Lactation, orexin effects, 123 Laterodorsal tegmental nucleus (LDT), vigilance control, 167, 182, 190 LC, see Locus ceruleus LDT, see Laterodorsal tegmental nucleus Leptin, feeding regulation, 101, 102, 329 narcolepsy patient findings, LHRH, see Luteinizing hormone-releasing hormone

5 Index 393 Limbic encephalopathy, orexin levels in cerebrospinal fluid, 302 Locus ceruleus (LC), network actions of orexin, 56 orexin fibers, 37 orexin receptors, 45 vigilance control by noradrenergic neurons, 181, 182, 189, 191 Luteinizing hormone-releasing hormone (LHRH), estrus cycle control, 119, 120 orexin actions on neurons, 120, 121 M MAP, see Mean arterial pressure MCH, see Melanin-concentrating hormone Mean arterial pressure (MAP), orexin effects, Medulla, orexin receptor expression, 37 Melanin-concentrating hormone (MCH), narcolepsy postmortem brain studies, 274 neuron release induction by orexin, 56, 57 Methamphetamine, narcolepsy management, 226, 227 Methylphenidate, narcolepsy management, 226, 227, 371 Midbrain, orexin receptor expression, 37 Möbius syndrome, symptomatic cataplexies, 297 Modafanil, narcolepsy management, 226, 227, 371 Monoamine oxidase-a, gene polymorphisms in narcolepsy, 281 Motor function, direct versus indirect actions of orexin, 210, 212, 213 exercise induction of orexin, 210 neurocircuitry of orexin activation, 215, 216 MSLT, see Multiple sleep latency test Multiple sclerosis, orexin levels in cerebrospinal fluid, symptomatic narcolepsy, 293, 294 Multiple sleep latency test (MSLT), canine narcolepsy, 235 narcolepsy diagnosis, 225, 226, 269 Murine narcolepsy models, comparison with human and canine narcolepsy, 236, 237, 369 orexin knockout mouse, cataplexy, excessive sleepiness, 259, 260 feeding behavior, 263 phenotype, 255 orexin receptor knockout mice, feeding studies, 102, 103 OX 1 R, 260, 261, 368, 370 OX 2 R, 255, 257, , 368, 370 phenotypes, 16, 17 stress response studies, 137 orexin/ataxin-3 transgenic mice, feeding behavior, 263, 264 human narcolepsy relevance, 262, 263 overview, 262 rescue by ectopic overexpression of orexin peptide transgenes, , 365, 370, 373 transgenic rat comparison, 263 Myotonic dystrophy, orexin levels in cerebrospinal fluid, 299, 300 N Narcolepsy-cataplexy, see also Vigilance control, associated neurological diseases and orexin levels, 293, 294, autoimmunity, see HLA-DQB1*0602 body weight, 214, 215 body weight, see Body weight clinical features, autonomic behaviors, 223, 224 cataplexy, 213, 224, 268 excessive daytime sleepiness, 223, 236, 288, 289, 368 hallucinations, 224, 225 sleep maintenance disturbances, 225 sleep paralysis, 225 comparison with dog and murine narcolepsy models, 236, 237, 369 diagnosis, criteria, 289, 293 multiple sleep latency test, 225, 226 orexin assays, 73, 76 78, 287 polysomnography, 225, 226 dogs, see Canine narcolepsy genetic marker, see HLA-DQB1*0602 heritability, 222, 269 history of study, 155, 221, 222 idiopathic narcolepsy, 287, 289, 293, 294

6 394 Index metabolic disturbances, 101, 102 mouse models, see Murine narcolepsy models orexin levels, assays, 73, 76 78, 287 atypical cases, 276, 277 idiopathic hypersomnia, indications and significance of testing, 279, 280 typical cases, 276 orexin signaling defects, 4, 192 postmortem brain studies, prevalence, 222, 269, 368 psychiatric disorder differential diagnosis, see Depression; Schizophrenia; Substance abuse stress role in onset, 281 symptomatic cataplexy, Coffin-Lowry syndrome, 296, 297 focal/generalized central nervous system invasion, 295, 296 Möbius syndrome, 297 Niemann-Pick disease, 295 Norrie disease, 296 treatment, anticataplectic agents, 226, 227, 370, 371 cell therapy, 380, 381 gene therapy, 381 γ-hydroxybutyric acid, , 370, 371 orexin replacement therapy, administration routes, 379 canine narcolepsy studies, 248, 249, central penetration, 376, 377 criteria, 367 mouse studies, , 365, 370, 373 orexin receptor agonists, , 365, prospects, 381, 382 secondary deficit considerations, 376 wake-promoting agents, 226, 227, 370, 371 Neuronal responses, orexin, intracellular calcium increase, 51, 52 nonselective cation channel activation, 46, 47 overview, 45 potassium channel depression, 49, 50 sodium current enhancement, 46 sodium/calcium exchanger activation, synaptic activity, neurotransmitter release increase, 52, 53, 56, 57 network actions, 53, 55, 56 Neurons, orexin projections, activation by fasting, 168 ascending projections from hypothalamus, 25, 26, 31, 32 circadian fluctuations, 155, 156 comparison with other hypothalamic projections, 22 descending projections from hypothalamus, 33, 37 diffuse nature, 24 electrophysiologic studies in transgenic mice, acetylcholinergic inputs, 66, 67 GABAergic inputs, 62 glutamatergic inputs, 62 histaminergic inputs, 67 noradrenergic inputs, 63, 65, 66 serotonergic inputs, 62, 63 firing rate, 175 functional implications of distribution, 38, 39 green fluorescent protein expression in transgenic mice, 61 lateral hypothalamus, 21, 22, 24, 175 markers, 22 metabolic regulation, 22 orexin peptide types, 22 sleep/wake behavior integration with other hypothalamic functions, 197, 198 stress effects on orexin-a neurons, techniques for study, 23, 24 Neuropeptide Y (NPY), feeding regulation, 101, 102 neuron release induction by orexin, 57 receptors, orexin neuron expression, 22 Niemann-Pick disease type C (NPC), orexin levels in cerebrospinal fluid, 288, 299 symptomatic cataplexy, 295 Noradrenaline, noradrenergic inputs to orexin neurons, 63, 65, 66, 176

7 Index 395 noradrenergic loop arousal circuits activated by orexins, 144 orexin-a correlation, 109 vigilance control by noradrenergic neurons, 181, 182 Norrie disease, symptomatic cataplexy, 296 NPC, see Niemann-Pick disease type C NPY, see Neuropeptide Y O Obesity, counterregulation by orexin, 114, 115 Orexin, assays, see Assays, orexin autonomic function, see Autonomic function, orexin circadian rhythms, clinical applications, 7, 8 feeding behavior modulation, see Feeding behavior functional overview, 4, 5, 209, 317 gene mutation screening in narcolepsy, gene structure and expression regulation, 15, 350 history of study, 3 5, 13, 143, 144 hormone interactions, see specific hormones integrative physiology, 5 7 knockout mice, vigilance control studies, 163, 165, 166, 192 motor function, see Motor function neuronal effects, see Neuronal responses, orexin neurons, see Neurons, orexin projections processing, 14 replacement therapy, see Narcolepsycataplexy stress response, see Stress response structure-activity relationships, 17, 18, vigilance control, see Vigilance control Orexin-A, discovery, 13 gastric acid secretion effects, 103 sequence, 13, 14 structure, 368, 369 structure-activity relationships, 17, 18, 351 Orexin-B, discovery, 13 sequence, 13, 14 structure, 368, 369 structure-activity relationships, 17, 18, 351, 352 Orexin receptors, agonist design, antagonists, autonomic function, 111, 112 binding regions of orexins, 17, 18, functional implications of distribution, 38, 39 gene mutation screening in narcolepsy, genes, 17 G protein activation, see [ 35 S]GTPγS autoradiography knockout mice, see Murine narcolepsy models ligand specificity, 15, 16, 23, 350 signaling, 18, 19, 350, 351 splice variants, 17 techniques for study, 23, 24 three-dimensional structure of OX 2 R, 351 transcript distribution in rat brain, forebrain, OX 1 R, 32 OX 2 R, 33 hypothalamus, OX 1 R, 25, 27, 28 OX 2 R, 25, 29, 30 midbrain, pons, and medulla, OX 1 R, 37 OX 2 R, 37 overview, 17, 107 table, types, 15, 16, 23 P Paraneoplastic syndrome, orexin levels in cerebrospinal fluid, 308 Paraventricular nucleus (PVN), orexin effects on neurons, Parkinson s disease, orexin levels in cerebrospinal fluid, 303 Pedunculopontine tegmental nucleus (PPT), arousal circuits activated by orexins, 144, 145, 149 vigilance control, 167, 182, 190 Pemoline, narcolepsy management, 226, 227

8 396 Index Pituitary, direct actions of orexin, 127 Pons, orexin receptor expression, 37 Potassium channel, orexin depression, 49, 50 PPT, see Pedunculopontine tegmental nucleus Prader-Willi syndrome (PWS), orexin levels in cerebrospinal fluid, 288, 298, 299 Progressive supranuclear palsy (PSP), orexin levels in cerebrospinal fluid, 303 Prolactin, suppression by orexin, 122, 123 Protriptyline, cataplexy management, 227 PSP, see Progressive supranuclear palsy Psychiatric disorders, see Depression; Schizophrenia; Substance abuse, PVN, see Paraventricular nucleus PWS, see Prader-Willi syndrome R Radioimmunoassay (RIA), orexin, Raphe nuclei, orexin fibers, 33 vigilance control, 189 Rasmussen s syndrome, orexin levels in cerebrospinal fluid, 303 Renal sympathetic nerve activity (RSNA), orexin effects, RIA, see Radioimmunoassay RSNA, see Renal sympathetic nerve activity S [ 35 S]GTPγS autoradiography, advantages and limitations, applications, 83 G protein activation, 84 historical perspective, 83 orexin-stimulated binding studies, prospects for study, 92, 93 SB , orexin receptor antagonism, 353, 354 SB , orexin receptor antagonism, 353, 354 SB , orexin receptor antagonism, 353, 354 SB , orexin receptor antagonism, 353, 354 SB , orexin receptor antagonism, Schizophrenia, differential diagnosis from narcolepsy, 319 symptoms related to orexin effects, 321, 322 SCN, see Suprachiasmatic nucleus Secretogranin II, orexin neuron expression, 22 Selective serotonin reuptake inhibitors (SSRIs), cataplexy management, 226, 227, 371 Selegiline, narcolepsy management, 227 Serotonin, circadian patterns, 322 neuron release induction by orexin, 56 serotonergic inputs to orexin neurons, 62, 63, 176 vigilance control by serotonergic neurons, 179, 181 Sleep, canine narcolepsy REM sleep disturbances, 235, 240 hypothalamic promoting systems, 193 maintenance disturbances in narcolepsy, 225 serotonin release, 322 two-process model, 156 Sleep/wake cycle, see Vigilance control SN, see Substantia nigra Sodium/calcium exchanger, orexin activation, Sodium channel, orexin activation, 46 Spinal cord, orexin fibers, 37 SSRIs, see Selective serotonin reuptake inhibitors Stress response, knockout mouse studies, 137 orexin mediation, 136, 137 paraventricular nucleus, stress effects on orexin-a neurons, stress hormones and orexin response, stressor effects on orexin expression, 137 Stroke, orexin levels in cerebrospinal fluid, 301 Substance abuse, differential diagnosis from narcolepsy, 320 symptoms related to orexin effects, 325 Substantia nigra (SN), vigilance control by dopaminergic neurons, 181 Suprachiasmatic nucleus (SCN), timing of sleep and wakefulness, 196, 197

9 Index 397 T Thyroid-releasing hormone (TRH), narcolepsy patient findings, 335, 336 suppression by orexin, 123, 124 Thyroid-stimulating hormone (TSH), narcolepsy patient findings, 335, 336 suppression by orexin, 123, 124 TMN, see Tuberomammilary nucleus TNF-α, see Tumor necrosis factor-a TRH, see Thyroid-releasing hormone, Tricyclic antidepressants, cataplexy control, 241, 371 TSH, see Thyroid-stimulating hormone Tuberomammilary nucleus (TMN), canine narcolepsy role, 247, 248 histamine response of orexin fibers, 56 mastication activation of neurons, 103 orexin receptors, 31 vigilance control by histaminergic neurons, 167, , 191 Tumor necrosis factor-α (TNF-α), gene polymorphisms in narcolepsy, 281 V Venlafaxine, cataplexy management, 227, 371 Ventral tegmental area (VTA), reward circuit and arousal circuits activated by orexins, 145 vigilance control by dopaminergic neurons, 181 Ventrolateral preoptic area (VLPO), aminergic nuclei inhibition, 182, 183 dynamic control of behavioral state, 193, 194 sleep role, 193 Ventromedial nucleus (VMH), orexin fibers, 24 orexin receptors, 25, 107 Vigilance control, aminergic and cholinergic systems, aminergic nuclei inhibition by ventrolateral preoptic area, 182, 183 cholinergic neurons, 182 dopaminergic neurons, 181 histaminergic neurons, , 191 noradrenergic neurons, 181, 182 serotonergic neurons, 179, 181 arousal circuits activated by orexins, basal forebrain, 145 brainstem cholinergic nuclei, 144 hypothalamic-pituitary-adrenal axis, 146 intrahypothalamic network, 144, 145 noradrenergic loop, 144 ventral tegmental area reward circuit, 145 arousal threshold setting by orexins, 146, 147, 149 behavioral state control by orexin, brainstem role, circadian fluctuations of orexin neurons, 155, 156 dynamic control of behavioral state and orexin stabilization, Fos, sleep-related fluctuations in orexin neurons, 161, 162, 192, 193 hypothalamic timing of sleep and wakefulness, 196, 197 orexin knockout mice studies, 163, 165, 166 orexin neuron integration of sleep/wake behavior with other hypothalamic functions, 197, 198 orexin tonus changes across sleep/wake cycle, cerebrospinal fluid measurements, diurnal animal studies, 161 manipulations affecting circadian and homeostatic regulation of sleep in rats, experimental behaviors and manipulations, 166, 167 general concerns, level fluctuations in brain parenchyma, 159 orexin-a release in extracellular space of rats, 162, 163 prospects for study, 168, 169, 198 sleep deprivation and orexin release, 210 sleep two-process model, 156 VLPO, see Ventrolateral preoptic area VMH, see Ventromedial nucleus VTA, see Ventral tegmental area W Wakefulness, see Vigilance control Wernicke s encephalopathy, orexin levels in cerebrospinal fluid, 302

Narcolepsy. Jon R. Doud, MD Pulmonary Physician Midwest Center for Sleep Disorders Aurora, IL

Narcolepsy. Jon R. Doud, MD Pulmonary Physician Midwest Center for Sleep Disorders Aurora, IL Narcolepsy Jon R. Doud, MD Pulmonary Physician Midwest Center for Sleep Disorders Aurora, IL Narcolepsy A central nervous system disorder that is an important cause of persistent sleepiness. The second