Dynamic Brain State Alterations in Narcolepsy: A Hidden Markov Model Approach to Thalamocortical Instability and Symptom‐Specific Neural Correlates

NT1 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.