An increased incidence of narcolepsy in children was detected in Scandinavian countries where pandemic H1N1 influenza ASO3-adjuvanted vaccine was used. A campaign of vaccination against pandemic H1N1 influenza was implemented in France using both ASO3-adjuvanted and non-adjuvanted vaccines. As part of a study considering all-type narcolepsy, we investigated the association between H1N1 vaccination and narcolepsy with cataplexy in children and adults compared with matched controls; and compared the phenotype of narcolepsy with cataplexy according to exposure to the H1N1 vaccination. Patients with narcolepsy-cataplexy were included from 14 expert centres in France. Date of diagnosis constituted the index date. Validation of cases was performed by independent experts using the Brighton collaboration criteria. Up to four controls were individually matched to cases according to age, gender and geographic location. A structured telephone interview was performed to collect information on medical history, past infections and vaccinations. Eighty-five cases with narcolepsy-cataplexy were included; 23 being further excluded regarding eligibility criteria. Of the 62 eligible cases, 59 (64% males, 57.6% children) could be matched with 135 control subjects. H1N1 vaccination was associated with narcolepsy-cataplexy with an odds ratio of 6.5 (2.1–19.9) in subjects aged <18 years, and 4.7 (1.6–13.9) in those aged 18 and over. Sensitivity analyses considering date of referral for diagnosis or the date of onset of symptoms as the index date gave similar results, as did analyses focusing only on exposure to ASO3-adjuvanted vaccine. Slight differences were found when comparing cases with narcolepsy-cataplexy exposed to H1N1 vaccination (n = 32; mostly AS03-adjuvanted vaccine, n = 28) to non-exposed cases (n = 30), including shorter delay of diagnosis and a higher number of sleep onset rapid eye movement periods for exposed cases. No difference was found regarding history of infections. In this sub-analysis, H1N1 vaccination was strongly associated with an increased risk of narcolepsy-cataplexy in both children and adults in France. Even if, as in every observational study, the possibility that some biases participated in the association cannot be completely ruled out, the associations appeared robust to sensitivity analyses, and a specific analysis focusing on ASO3-adjuvanted vaccine found similar increase.

Study Objective:. Prior research has identified five common genetic variants associated with narcolepsy with cataplexy in Caucasian patients. To replic

NARCOLEPSY-CATAPLEXY, A DISEASE CAUSED BY THE LOSS OF ∼70,000 HYPOCRETIN CELLS IN THE HYPOTHALAMUS AFFECTS ∼20 PER 100,000 INDIVIDUALS, with an incidence of ∼ 0.3–0.6 per 100,000 person-years.^1,2 Onset is most typically in the teens, and cases with onset before age 6 or after 40 are rare in Western Europe and North America.³ The disease is extremely tightly associated with human leukocyte antigen (HLA) DQB1*0602⁴, so that DQB1*0602 negative cases without documented loss of hypocretin cells, as measured by cerebrospinal fluid (CSF) hypocretin levels, are exceptional; only 5 such cases have been reported in the literature. The cause of narcolepsy is likely autoimmune based on the HLA association, association with T-cell receptor polymorphisms,⁵ and recently reported Tribbles 2 autoantibodies.⁶

The Stroop Color-Word Test-Victoria version (VST) is a measure of executive function commonly used in neuropsychological evaluation. Because of its short administration time, the VST seems particularly appropriate for use in geriatric populations and with those suffering from dementia and who are prone to fatigue during neuropsychological examination. In this study, we examine the influence of demographic characteristics on VST score and present descriptive data for a sample of 244 elderly French speakers (50–94 years of age). Normative data corrected for age and education are provided for clinical use. Furthermore, by comparing the VST performance of patients with the Alzheimer-type dementia to that of 40 matched healthy controls, we provide clinical evidence suggesting that the VST has a clinical utility in the assessment of inhibition in AD.

The associations between depressive symptoms and hypersomnia are complex and often bidirectional. Of the many disorders associated with excessive sleepiness in the general population, the most frequent are mental health disorders, particularly depression. However, most mood disorder studies addressing hypersomnia have assessed daytime sleepiness using a single response, neglecting critical and clinically relevant information about symptom severity, duration and nighttime sleep quality. Only a few studies have used objective tools such as polysomnography to directly measure both daytime and nighttime sleep propensity in depression with normal mean sleep latency and sleep duration. Hypersomnia in mood disorders, rather than a medical condition per se, is more a subjective sleep complaint than an objective finding. Mood symptoms have also been frequently reported in hypersomnia disorders of central origin, especially in narcolepsy. Hypocretin deficiency could be a contributing factor in this condition. Further interventional studies are needed to explore whether management of sleep complaints improves mood symptoms in hypersomnia disorders and, conversely, whether management of mood complaints improves sleep symptoms in mood disorders.