Stanford Medicine Newsletter Updates For the Local Community

 

His dear Watson

Chihuahua makes explaining narcolepsy look elementary

Emmanuel Mignot, MD, PhD, brings his pet Chihuahua to the clinic to help demonstrate narcolepsy to young patients.

   

There’s Watson and Crick. Holmes and Watson. And Watson and Mignot. Or, more properly, Watson, the narcoleptic Chihuahua, and Emmanuel Mignot, MD, PhD, director of the Stanford Center for Sleep Sciences and Medicine.

Mignot found Watson in 2014, not long after the passing of his dog Bear, a black Belgian Shipperke, who was also narcoleptic. Still grieving, Mignot received a call from a veterinarian in Vermont who had a very sleepy Chihuahua puppy in need of a home. Mignot had doubts: It felt too soon for a new dog. And he’d never particularly liked Chihuahuas.

But the narcolepsy connection proved too strong. Mignot, professor of psychiatry and behavioral sciences, has devoted his professional life to researching and treating the debilitating sleep-inducing condition. In 1999 he discovered the gene that triggers narcolepsy in dogs.

So just weeks after the breeder’s call, Mignot was on a flight to the East Coast, returning to California with a new, football-sized family member named after the Sherlock Holmes sidekick, the IBM computer personality and the geneticist.

A recent morning found the dog-and-doctor duo in a small bedroom in the Stanford sleep center’s Redwood City clinic. They were there to meet Jackson, a young patient, and his family, who had traveled from Florida to see Mignot. A slender, bespectacled boy of 10, Jackson had been diagnosed with narcolepsy only the year before. Although Watson moonlights as an ambassador of narcolepsy — helping children understand and cope with the disease — he is a family pet, pure and simple.

The family, including Jackson’s school-aged sister, came to the clinic early for the opportunity to meet Watson. As they crowded into the small room, Mignot lifted up an unzipped dog carrier (Watson’s “Cadillac”), and Watson — all ears and muzzle — tentatively stepped out.

“It’s a bit early for him,” Mignot apologized, pressing the dog against his chest and cooing to him in French. Although Watson is a bit shy around newcomers, Mignot takes him into the clinic when he treats children with narcolepsy, a growing population that can develop particularly severe symptoms, such as almost constant sleepiness or sudden episodes of muscle paralysis that occur with specific emotions.

As the children gingerly reached out to pet the Chihuahua, Mignot pulled out several small baggies packed with chicken. Watson watched eagerly, his tail wagging frantically. Mignot placed a sliver of chicken on his finger, holding it in front of Watson’s twitchy, wet nose. Watson inhaled, then staggered backward, struggling to remain standing as he scarfed up the meat.

To this crowd, Mignot had no need to explain what was happening. Excited by the food, Watson was having cataplectic attacks. When he experienced strong emotions, the dog’s muscles went limp and his eyelids drooped. Within seconds, Watson would regain command and lunge for the food. Then, he’d struggle again. To cope with the attacks, Watson sometimes backs into a surface he knows will support him.

Jackson nodded knowingly. He tries to ward off his own attacks by shaking or smacking his lips, he said. But Watson doesn’t receive medication, Mignot said. He doesn’t have to go to school or work, and he can nap frequently during the day.

Jackson, like many who visit the Stanford Center for Narcolepsy, has been treated elsewhere. The disease is relatively rare — affecting one in 2,000 people — and most physicians don’t receive adequate (or any) training in narcolepsy, Mignot said. In humans, it results when immune cells mistakenly attack nerve cells that produce hypocretin, a compound that promotes wakefulness in the brain. There currently is no way to correct the disorder, so doctors treat the symptoms, which include daytime sleepiness, sleep disturbances and cataplectic attacks, with a combination of sedatives, stimulants and antidepressants. This balancing act can leave patients amped up on powerful stimulants, which can produce new behavioral symptoms.

Mignot is hopeful that a drug will be developed that can directly deliver hypocretin to the cells that need it. Several groups are making inroads testing substances using animal models, he said. Until then, Watson assists him in spreading the word about narcolepsy and helping patients, particularly children, learn how to cope with their symptoms.

Learn more about the Stanford Center for Sleep Sciences and Medicine at sleep.stanford.edu.

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