Rolf Fronczek, PhD, MD: Narcolepsy and Opiates

November 3, 2018

The neurologist discussed an analysis of findings suggesting that opiate agonists may have a role in the treatment of narcolepsy.

“This could also have clinical implications not only for opiate users, maybe as an explanation for their addiction, but also for narcolepsy, maybe as a treatment.”

Rolf Fronczek, PhD, MD, Department of Neurology, Leiden University Medical Centre, Sleep-Wake Centre SEIN, sat with NeurologyLive at the 24th Congress of the European Sleep Research Society in Basel, Switzerland, to discuss the connection between narcolepsy and opiates.

In a collaboration with researchers from UCLA, Fronczek and colleagues examined a number of hypocretin neurons in postmortem brains and found that some individuals presented with an unexpectedly large cell number increase. Looking back, researchers discovered that those patients were opiate addicts. Similar increases in hypocretin-producing cells were induced in a mouse model by administration of morphine.

With an interest in these findings, Fronczek and colleagues examined cases of individuals with narcolepsy from the Dutch Brain Bank. Similar to previous findings, researchers found that in 1 patient where hypocretin neurons were present, the individual did in fact use opiates and experienced an improvement in narcolepsy symptoms during the time period. There was about a 50% return of hypocretin neurons compared to a typical narcoleptic brain where there are hardly any neurons left.

The clinical implications of these findings may not only be relevant for opiate users, as an increased number of hypocretin-producing cells may play a role in maintaining opiate addiction, but also raises the question about a potential treatment option for narcolepsy.

REFERENCE

Thannickal T, John J, Shan L, et al. Opiates increase the number of hypocretin-producing cells in human and mouse brain and reverse cataplexy in a mouse model of narcolepsy. Science Translational Medicine. 2018;10(447).

doi

: 10.1126/scitranslmed.aao4953.