0947 CLINICAL CHARACTERISTICS OF CHILDHOOD NARCOLEPSY FOLLOWING THE H1N1 PANDEMICS: PRELIMINARY DATA FROM THE PEDIATRIC WORKING GROUP OF THE SLEEP RESEARCH NETWORK

Abstract

Introduction: An increased incidence of narcolepsy in children and adolescents has been reported after the 2009 H1N1 pandemic in Europe and China. In addition, some studies have indicated different clinical characteristics in recent cases. However, no data have been reported from the United States. Method(s): The Pediatric Working Group of the Sleep Research Network (PED-SRN) has conducted a retrospective review with a prospective follow-up interview on Pediatric Narcolepsy since 2010. This multi-center collaborative project consists of 20 US pediatric sleep centers. One of the main objectives is to compare clinical characteristics between recent cases (2009-present) and conventional cases (prior to 2009). Subjects aged 0-18 years at the time of narcolepsy diagnosis from 2000-2015 were included. Secondary narcolepsy cases were excluded. The data were obtained from medical records with an additional interview from research coordinators. The study was approved by the IRB from each site, with informed consent when additional interview was needed. Result(s): 652 subjects were enrolled into the study, and 648 completed records were analyzed, including 478 recent[R] and 170 conventional[C] cases. The age at EDS onset(9.6 +/- 3.7[R] vs 9.8 +/- 3.8[C]) and sex(male 51.5%[R] vs 50%[C]) were not different between the two groups. The proportion of African American patients was higher in recent cases(43.1% [R]vs 34.7%[C], P<0.05). Although cataplexy was higher in the conventional cases(65.5%[R] vs 77.1%[C], P<0.05), atypical cataplexy- (17.9%[R] vs 16.0%[C], P<0.05) and persistent frequent cataplexy after treatment(10.9%[R] vs 4.6%[C], P<0.05) were higher in the recent cases. Excessive weight gain(47.9%[R] vs 41.7%[C], P<0.05), sleep onset insomnia(84.1%[R] vs 80%[C], P<0.05), restless sleep(85.6%[R] vs 78.9%[C], P<0.05), and sleep walking(77.4%[R] vs 72.9%[C], P<0.05) were also higher in the recent cases. The presence of HLA-DQB1*0602 was not different between the two groups. The history of recent streptococcal infection(12.6%[R] vs 9.4% [C], P<0.05) and influenza infection( 5.9%[R] vs 2.9%[C], P<0.05) were higher in the recent cases. Conclusion(s): Conventional and recent cases of narcolepsy showed differences, with recent cases having a higher proportion of African Americans, higher rates of recent streptococcal and influenza infections, and more severe manifestation with higher rates of atypical cataplexy and persistent frequent cataplexy after treatment.