Compound narcolepsy: development of biochemical imbalance.

In a review of existing literature, compound narcolepsy is shown to involve not only problems of sleep regulation, but also autonomic, hormonal, emotional, and possibly motor and cognitive dysfunctions, strongly implicating the hypothalamus, limbic system, and possibly the striatum and cortex in the disorder. Neurochemical studies and the pattern of narcoleptic symptoms support the idea of a dynamic imbalance between dopamine and acetylcholine in the etiology of the disorder. What is known about the natural history of compound narcolepsy suggests a developmental course beginning with fluctuations in dopamine release, followed by supersensitivity of dopamine autoreceptors, and later followed by a pattern of intrinsic oscillations and reciprocal "overshoots" in release of dopamine and acetylcholine to account for the typical sequence of appearance of narcoleptic symptoms.