ArticleBrain and behavior2026
Dynamic Brain State Alterations in Narcolepsy: A Hidden Markov Model Approach to Thalamocortical Instability and Symptom-Specific Neural Correlates.
Article in Brain and behavior, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundNarcolepsy Type 1 (NT1) results from loss of hypothalamic orexin neurons, leading to unstable sleep-wake transitions. However, how this manifests as dynamic whole-brain functional state instability remains poorly characterized.
methodsWe applied Hidden Markov Modeling (HMM) to resting-state functional magnetic resonance imaging (fMRI) data from 30 patients with NT1 and 30 age- and sex-matched healthy controls to identify recurrent brain states, quantify their fractional occupancy (FO), and examine associations with clinical symptoms-specifically excessive daytime sleepiness (Epworth Sleepiness Scale, ESS) and hallucinations.
resultsFive distinct dynamic brain states were identified. Compared to controls, NT1 patients showed significantly reduced FO in State 1 (thalamocortical arousal/sensory gating; p
conclusionsNT1 is associated with reduced stability of a thalamocortical alertness state and increased expression of REM-like limbic-subcortical network configurations. State 1 occupancy is relatively elevated in patients with hallucinations, while State 4 shows a positive association with excessive daytime sleepiness and features of REM dissociation. These findings support a dynamic, whole-brain systems-level framework for understanding symptom heterogeneity in NT1.
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