Hypothalamic lesion and Excessive Daytime Sleepiness (SLE 2018)

pattismith

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Association found between Systemic Lupus Erythematosus / Excessive Daily Sleepiness / lesions in the hypothalamus.... With or without low Hypocretin / Orexin ...

Cerebrospinal fluid orexin-A levels in systemic lupus erythematosus patients presenting with excessive daytime sleepiness
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K Suzuki, M Miyamoto, T Miyamoto, ...
First Published May 31, 2018
https://doi.org/10.1177/0961203318778767


Abstract
Objective


Involvement of the hypothalamus is rare in patients with systemic lupus erythematosus (SLE). In this study, we measured cerebrospinal fluid (CSF) orexin-A levels in SLE patients with hypothalamic lesions to investigate whether the orexin system plays a role in SLE patients with hypothalamic lesions who present with excessive daytime sleepiness (EDS).

Methods

Orexin-A levels were measured in CSF from four patients with SLE who presented with hypothalamic lesions detected by MRI.

Three patients underwent repeated CSF testing.
All patients met the updated American College of Rheumatology revised criteria for SLE.

Results

Tests for serum anti-aquaporin-4 antibodies, CSF myelin basic protein and CSF oligoclonal bands were negative in all patients.

All patients presented with EDS.

Low to intermediate CSF orexin-A levels (92–180 pg/ml) were observed in three patients in the acute stage, two of whom (patients 1 and 2) underwent repeated testing and showed increased CSF orexin-A levels, reduced abnormal hypothalamic lesion intensities detected by MRI and EDS dissipation at follow-up.

In contrast, CSF orexin-A levels were normal in one patient (patient 4) while in the acute stage and at follow-up, despite improvements in EDS and MRI findings.

Patient 4 showed markedly increased CSF interleukin-6 levels (1130 pg/ml) and a slightly involved hypothalamus than the other patients.


Conclusions


Our findings suggest that the orexinergic system has a role in EDS in SLE patients with hypothalamic lesions.

Furthermore, cytokine-mediated tissue damage might cause EDS without orexinergic involvement.
 

ahmo

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Thanks @pattismith. I used hypothalamic glandular for a few years. Initially, it stopped my severe reaction to heat. I also took pituitary, hoping for improved sleep, and adrenal glandular. Adrenal is the only once I continue, down from twice a day to one. I don't know that I have EDD, but I'm certainly not wide awake. Might try the hypothalamus again.
 

pattismith

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Thanks @pattismith. I used hypothalamic glandular for a few years. Initially, it stopped my severe reaction to heat. I also took pituitary, hoping for improved sleep, and adrenal glandular. Adrenal is the only once I continue, down from twice a day to one. I don't know that I have EDD, but I'm certainly not wide awake. Might try the hypothalamus again.
The wake/sleep hypothalamic control is separate from the hypothalamic hormonal control upon pituitary. (Hypothalamic has a wide range of effects on the brain and the body apart from the pituitary control)
 

pattismith

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Stress-induced increased expression of TLR2, TLR3, and TLR4 genes in hypothalamic tissue | Yankelevich | Medical academic journal (eco-vector.com)

The aim of this work was to study the expression of Toll-like receptors (TLRs) genes in the hypothalamic structures of the brain, after the application of acute stressful effects.

A hypothesis has been put forward about Toll-like receptors as a key link in the mechanisms of the implementation of a stress reaction, including at the level of the central nervous system (CNS).

The important role of TLR in the pathogenesis of stress-mediated diseases of the central nervous system is assumed.

The expression of TLR2, TLR3, and TLR4 genes in rat hypothalamus was studied for after 3 hours after the application of acute emotional-physical stress.

A reliable increase in the level of gene expression of all three receptors at the mRNA level in stressed animals was established compared with the control.

The obtained experimental data indicate the activation of the system of Toll-like receptors at the level of the central nervous system under stress.

The activation of several receptors of the TLR family with different specificities in the absence of an increase in microbial load, including at the level of pathogen-associated molecular factors (PAMP), may also indicate the likely significant role of endogenous TLR ligands in the described processes.