An etiology of narcolepsy-cataplexy and a proposed cataplexy neuromechanism.

Narcolepsy-cataplexy is an idiopathic sleep disorder that reflects a complex neuropathology. Surveys and physiological investigations indicate that genetic and stress factors are involved in its onset and that stress is associated with symptomatic fluctuations and exacerbations of its clinical course. This paper summarizes the literature regarding the evolution, characteristics and treatment of the disorder. A comprehensive etiology is advanced, integrating neurophysiological and psychological factors specific to narcolepsy-cataplexy with recent advances in blood pressure regulation. Moreover, a testable neuromechanism of cataplexy is proposed, based on longitudinal effects of chronic drowsiness, the strong hypnogenic effect obtained by carotid sinus stimulation, an experimental animal model of narcolepsy-cataplexy, the adaptive characteristics of baroreceptors and, finally, the interconnections between CNS sleep and blood pressure regulators of the brain stem. Through better understanding of the causes and mechanisms of narcolepsy-cataplexy, more effective treatments and preventive measures can be developed, high risk populations identified, and, perhaps, a cure found. Suggestions for future physiological and epidemiological research are made.