Ulf Kallweit1,2, Claudio L A Bassetti3, Michael Oberholzer1, Rolf Fronczek4, Mathieu Béguin1, Matthias Strub5, Gert Jan Lammers4,6. 1. Department of Neurology, University Hospital of Bern (Inselspital), Freiburgstrasse 18, 3010, Bern, Switzerland. 2. Institute for Immunology, University Witten/Herdecke, Witten, Germany. 3. Department of Neurology, University Hospital of Bern (Inselspital), Freiburgstrasse 18, 3010, Bern, Switzerland. claudio.bassetti@insel.ch. 4. Leiden Medical University Center and University of Leiden, Leiden, The Netherlands. 5. Practice for Neurology, Basel, Switzerland. 6. Sleep-Wake Center SEIN, Heemstede, The Netherlands.
Abstract
BACKGROUND: There are increasing data suggesting the involvement of the immune system in narcolepsy. The co-occurrence of narcolepsy with other autoimmune disorders (including multiple sclerosis, MS) is rare. PATIENTS AND METHODS: International multicenter sleep center survey and literature review on narcolepsy with (NC) and without (NwC) cataplexy. RESULTS: A total of 26 patients (pts), 6 in the survey and 20 in the literature were found. Two different types of association were identified: (1) Symptomatic type (5 pts): MS preceding the onset of narcolepsy, which was always without cataplexy (NwC); sleep onset REM episodes (SOREM) and hypocretin deficiency were observed in some, and lesions in the hypothalamus in all patients. (2) Coexisting type (18 pts): MS preceding or following the appearance of NC with SOREM, hypocretin deficiency but no lesions in the hypothalamus. A positive effect of steroids, immunoglobulins or natalizumab on narcolepsy symptoms was observed in four patients. DISCUSSION: Narcolepsy and MS are rarely associated. In addition to NwC secondary to hypothalamic demyelination, some patients present a coexistence of MS with NC without detectable hypothalamic lesions. The rarity of reports on this association probably reflects underrecognition. The elucidation of underlying genetic and immune mechanisms needs further studies.
BACKGROUND: There are increasing data suggesting the involvement of the immune system in narcolepsy. The co-occurrence of narcolepsy with other autoimmune disorders (including multiple sclerosis, MS) is rare. PATIENTS AND METHODS: International multicenter sleep center survey and literature review on narcolepsy with (NC) and without (NwC) cataplexy. RESULTS: A total of 26 patients (pts), 6 in the survey and 20 in the literature were found. Two different types of association were identified: (1) Symptomatic type (5 pts): MS preceding the onset of narcolepsy, which was always without cataplexy (NwC); sleep onset REM episodes (SOREM) and hypocretin deficiency were observed in some, and lesions in the hypothalamus in all patients. (2) Coexisting type (18 pts): MS preceding or following the appearance of NC with SOREM, hypocretin deficiency but no lesions in the hypothalamus. A positive effect of steroids, immunoglobulins or natalizumab on narcolepsy symptoms was observed in four patients. DISCUSSION: Narcolepsy and MS are rarely associated. In addition to NwC secondary to hypothalamic demyelination, some patients present a coexistence of MS with NC without detectable hypothalamic lesions. The rarity of reports on this association probably reflects underrecognition. The elucidation of underlying genetic and immune mechanisms needs further studies.
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