title: Transient Impact of Rituximab in H1N1 Vaccination-associated Narcolepsy With Severe Psychiatric Symptoms.
abstract: BACKGROUND
  Narcolepsy type 1 is an organic sleep disorder caused by the destruction of hypocretin producing neurons in hypothalamus. In addition to daytime sleepiness, the spectrum and severity of symptoms are very variable. Psychiatric comorbidity and phenomena resembling psychotic symptoms are also common. Current treatment options for narcolepsy are symptomatic but there are few case reports of positive effect of immunotherapy. We report a very severely affected young boy treated with rituximab (RXB).
  
  
  METHODS
  A 12-year-old boy developed narcolepsy after Pandemrix H1N1 vaccination in 2010. He started to express severe psychiatric symptoms shortly after the onset. Cataplexy and sleepiness were devastatingly disabling. Conventional treatments did not have any effect on symptoms so we decided to try RXB, chimeric human monoclonal antibody against CD20 expressed in B lymphocytes. After the first treatment his condition ameliorated dramatically. Unfortunately, the effect lasted only for 2 months. Following attempts did not show any effect.
  
  
  CONCLUSIONS
  Effect of RXB on narcolepsy has not been reported before. Remarkable but short-lasting effect of RXB in narcolepsy is intriguing as it could imply that there is still ongoing B cell-mediated autoimmune response possible contributing to symptoms in narcolepsy.
authors: Departments of *Neurology ‡Child Neurology, Central Finland Central Hospital, Jyväskylä †Helsinki Sleep Clinic, Vitalmed Research Centre §Department of Neurological Sciences, University of Helsinki, Helsinki, Finland.
authors: Tomi
authors: T
authors: Sarkanen
authors: Reija
authors: R
authors: Alén
authors: Markku
authors: M
authors: Partinen
mesh_terms: D000374:Aggression / Q000523:psychology; D002385:Cataplexy / Q000139:chemically induced / Q000188:drug therapy*; D002648:Child; D003702:Delusions / Q000139:chemically induced / Q000188:drug therapy* / Q000523:psychology; D006212:Hallucinations / Q000139:chemically induced / Q000188:drug therapy* / Q000523:psychology; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D053118:Influenza A Virus, H1N1 Subtype; D007252:Influenza Vaccines / Q000009:adverse effects; D007251:Influenza, Human / Q000517:prevention & control; D008297:Male; D009290:Narcolepsy / Q000139:chemically induced / Q000188:drug therapy*; D000069283:Rituximab / Q000627:therapeutic use*
chemical_list: D007155:Immunologic Factors; D007252:Influenza Vaccines; C556153:pandemrix; D000069283:Rituximab