Narcolepsy-Cataplexy: Is Streptococcal Infection a Trigger?

Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
Journal of clinical sleep medicine: JCSM: official publication of the American Academy of Sleep Medicine (Impact Factor: 2.83). 01/2013; 9(3):269-270. DOI: 10.5664/jcsm.2498
Source: PubMed

ABSTRACT Narcolepsy-cataplexy is an uncommon sleep disorder which may present in childhood. We report a case of an 8-year-old presenting with narcolepsy-cataplexy following a streptococcal infection. Autoimmune etiology for narcolepsy has been suggested. In our patient increased anti-streptolysin O and anti-DNAse B titers were noted. As suggested by recent cases, the streptococcal infection was likely a trigger for narcolepsy onset in this genetically predisposed child. The patient was initially diagnosed as having Sydenham chorea due to motor movements. However, these transient movements may be due to the narcolepsy onset. Narcolepsy in childhood may present with atypical symptoms; it might be difficult to obtain accurate history and can be misdiagnosed as in the reported case. A high index of clinical suspicion is needed to diagnose these patients.
Natarajan N; Jain SV; Chaudhry H; Hallinan BE; Simakajornboon N. Narcolepsy-cataplexy: is streptococcal infection a trigger? J Clin Sleep Med 2013;9(3):269-270.

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    • "In this case, the patient showed increase in the ASLO values when diagnosed with this affection. ASLO is an indication of a previous contact (during the past 2 months) with S. pyogenes (beta-hemolytic streptococcus of the A group) [20]. "
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    ABSTRACT: Streptococcalinfectionsaresuggestedasariskfactorfornarcolepsy.Thishypothesisis supported bythepresenceofanti-streptolysinantibodiesin65%ofpatientswith narcolepsy. Theseinfectionsareassociatedwiththeactivationofgeneralimmunityand concomitant increasedpermeabilityofblood–brain barrierafterTcellactivationduring inflammationandfever. It hasalsobeenshownasignificant associationbetweenbirthorderandnarcolepsyin genetically susceptiblepatients,withpositivityforHLA-DQB1n0602 allele.Watsonand colleagues showedasignificant associationbetweenbirthorderandnarcolepsyin genetically susceptiblepatients,withpositivityforHLA-DQB1n0602 allele.Inthatstudy, the diseasewaspredominantinyoungchildrencasescomparedtocontrols. We reportherethecaseofachilddiagnosedwithnarcolepsywithcataplexy,positivity for theHLA-DQB1n0602 andprevioushistoryofstreptococcalinfection.
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    • "In this case, the patient showed increase in the ASLO values when diagnosed with this affection. ASLO is an indication of a previous contact (during the past 2 months) with S. pyogenes (beta-hemolytic streptococcus of the A group) [20]. "
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    ABSTRACT: Streptococcal infections are suggested as a risk factor for narcolepsy. This hypothesis is supported by the presence of anti-streptolysin antibodies in 65% of patients with narcolepsy. These infections are associated with the activation of general immunity and concomitant increased permeability of blood-brain barrier after T cell activation during inflammation and fever.
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