Abstract
Objective: To identify narcolepsy related regional brain activity alterations compared with matched healthy controls. To determine whether these changes can be used to distinguish narcolepsy from healthy controls by recursive partitioning analysis (RPA) and receiver operating characteristic (ROC) curve analysis.Method: Fifty-one narcolepsy with cataplexy patients (26 adults and 25 juveniles) and sixty matched heathy controls (30 adults and 30 juveniles) were recruited. All subjects underwent a resting-state functional magnetic resonance imaging scan. Fractional low-frequency fluctuations (fALFF) was used to investigate narcolepsy induced regional brain activity alterations among adult and juveniles, respectively. Recursive partitioning analysis and Receiver operating curve analysis was used to seek the ability of fALFF values within brain regions in distinguishing narcolepsy from healthy controls.Results: Compared with healthy controls, both adult and juvenile narcolepsy had lower fALFF values in bilateral medial superior frontal gyrus, bilateral inferior parietal lobule and supra-marginal gyrus. Compared with healthy controls, both adult and juvenile narcolepsy had higher fALFF values in bilateral sensorimotor cortex and middle temporal gyrus. Also juvenile narcolepsy had higher fALFF in right putamen and right thalamus compared with healthy controls. Based on RPA and ROC curve analysis, in adult participants, fALFF differences in right medial superior frontal gyrus can discriminate narcolepsy from healthy controls with high degree of sensitivity (100%) and specificity (88.9%). In juvenile participants, fALFF differences in left superior frontal gyrus can discriminate narcolepsy from healthy controls with moderate degree of sensitivity (57.1%) and specificity (88.9%).Conclusion: Compared with healthy controls, both the adult and juvenile narcolepsy showed overlap brain regions in fALFF differences after case-control comparison. Furthermore, we propose that fALFF value can be a helpful imaging biomarker in distinguishing narcolepsy from healthy controls among both adults and juveniles.
Highlights
Narcolepsy is a chronic sleep disorder, characterized by excessive daytime sleepiness, cataplexy, sleep paralysis, hypnagogic, and hypnopompic hallucination and disturbed nocturnal sleep
By using recursive partitioning analysis and receiver operating characteristic (ROC) curve analysis, we speculated that the fALFF values in some brain regions were excellent in discriminating narcolepsy subjects from healthy controls in both adults and juvenile with high AUC value
In both the adult and juvenile participants, narcolepsy patients showed decreased fALFF in bilateral SFGmed, bilateral supra-marginal gyrus and bilateral inferior parietal lobule (IPL) compared with healthy controls, while narcolepsy patients showed increased fALFF in bilateral sensorimotor cortex (SMC) and bilateral middle temporal gyrus compared with healthy controls
Summary
Narcolepsy is a chronic sleep disorder, characterized by excessive daytime sleepiness, cataplexy, sleep paralysis, hypnagogic, and hypnopompic hallucination and disturbed nocturnal sleep. It is indicated that loss of hypocretin is thought to be an underlying cause to the sleeprelated changes and cataplexy, deficiency in hypocretin system can result in the abnormal cognition and emotion observed in narcolepsy patients [2]. Abnormal perfusion and glucose metabolism in the hypothalamus and prefrontal cortex has been detected among narcolepsy using PET and SPECT [5, 10]. A very recent PET research in a large group of junior narcolepsy patients observed that abnormality in many frontal and subcortical brain areas, exhibited significantly correlation with neuro-cognition performance [7]
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