Q Which part of the brain is affected in narcolepsy? I've also heard it called autoimmune.
A The core problem is the loss of the hypocretin (orexin)-secreting neurons in the hypothalamus of the brainstem. In type 1 narcolepsy, more than 90% of these cells are known to be destroyed through an autoimmune mechanism.
Detailed Answer
Hypocretin is a neurotransmitter secreted by the hypothalamus that stabilizes the wakefulness circuits throughout the brain. In type 1 narcolepsy, which is accompanied by cataplexy, more than 90% of these neurons are reduced by autoimmune attack, which can be confirmed by cerebrospinal fluid testing or polysomnography. In type 2 narcolepsy, which does not involve cataplexy, the decrease in hypocretin is mild or other mechanisms are involved.
Oriental Medicine Clinic Perspective
Rather than focusing on structural damage to the brain, Korean medicine approaches the condition as a decline in the function of two organ systems, the spleen (脾) and the heart (心). Even after neurons have been lost, the goal is to make the most of the remaining wakefulness function and to supplement spleen qi so that clear yang energy rises all the way to the head.
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