[SP5-3C-6] Narcolepsy in Children: Relationship to the H1N1 Influenza Vaccination, Association with Psychiatric and Cognitive Impairments and Consequences in Daily Life
Narcolepsy is a disabling lifelong sleep disorder. The purpose of this thesis was to study a population-based cohort of children with narcolepsy in western Sweden to determine the incidence and relationship with the H1N1 influenza vaccination, psychiatric comorbidity, cognitive profile and impact on daily life. Post-H1N1 influenza vaccination (PHV) narcolepsy was considered in patients with clinical onset within 10 months of vaccination. Psychiatric comorbidity was investigated using a test battery of semi-structured interviews and validated screening tools. The cognitive assessments were made by a clinical psychologist using age specific Wechsler Scales.
We identified 43 patients. The incidence of narcolepsy was 25 times higher in the period after the vaccination compared with the period before. The children in the PHV group had a lower age at onset and a more sudden onset than is generally seen. Psychiatric comorbidity was present in 43% of the patients in the PHV group; ADHD in 8/28, major depression in 6/30, general anxiety disorder in 3/30 and oppositional defiant disorder (ODD) in 2/30. In the non-post-H1N1 influenza vaccination (nPHV) narcolepsy group, 1/7 patients had ADHD in combination with ODD. The cognitive assessment showed decreased verbal comprehension and working memory in both patient groups. Furthermore, patients with psychiatric comorbidity had a significantly lower full-scale IQ and more severe impact on daily life.
The H1N1 influenza vaccination with Pandemrix represents a precipitating factor for narcolepsy in children. The identified high prevalence of psychiatric comorbidity and cognitive difficulties highlights the importance of a careful psychiatric and neuropsychological follow-up.
We identified 43 patients. The incidence of narcolepsy was 25 times higher in the period after the vaccination compared with the period before. The children in the PHV group had a lower age at onset and a more sudden onset than is generally seen. Psychiatric comorbidity was present in 43% of the patients in the PHV group; ADHD in 8/28, major depression in 6/30, general anxiety disorder in 3/30 and oppositional defiant disorder (ODD) in 2/30. In the non-post-H1N1 influenza vaccination (nPHV) narcolepsy group, 1/7 patients had ADHD in combination with ODD. The cognitive assessment showed decreased verbal comprehension and working memory in both patient groups. Furthermore, patients with psychiatric comorbidity had a significantly lower full-scale IQ and more severe impact on daily life.
The H1N1 influenza vaccination with Pandemrix represents a precipitating factor for narcolepsy in children. The identified high prevalence of psychiatric comorbidity and cognitive difficulties highlights the importance of a careful psychiatric and neuropsychological follow-up.