After nearly a century of narcolepsy research, the field was revolutionized by the discovery of hypocretin in 1998 and the subsequent association of hypocretin dysfunction with narcolepsy. Although the loss of hypocretin function as the cause of most typical cases of narcolepsy with cataplexy has been fairly well established, the role of hypocretin in most other forms of narcolepsy (the narcolepsy "borderland") has yet to be clarified. The cause of the hypocretin dysfunction, whether by autoimmune destruction or otherwise, is still unknown and is a critical component in our treatment or prevention of the disease. The partial efficacy of IVIG treatment early in the course of the disease, if confirmed, may open a new field of therapy for patients diagnosed close to the onset. Although narcolepsy is currently treated symptomatically and specific hypocretin receptor agonists are probably forthcoming, replacement of lost hypocretin neurons would presumably be an ideal technique to cure existing narcolepsy patients.
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