Türkiye’de H1N1 aşısına bağlı ortaya çıkan Narkolepsi- Katapleksi sendromu olgusu henüz bildirilmemiştir. H1N1 domuz gribi aşısı sonrasında Avrupa ülkelerinde narkolepsi-katapleksi endemisinin ortaya çıkması dikkatleri çekmiştir. Narkolepsi-Katapleksi sendromu, insan lökosit antijenleri (HLA-DQB1/0602) ile ilişkili, uyanıklıktan sorumlu hipokretin peptit eksikliğine bağlı gelişen nadir bir uyku hastalığıdır. In the presence of an underlying genetic predisposition, it was thought that H1N1 vaccination could trigger Narcolepsy-Cataplexy syndrome. Although there is no specific marker, temporal relationship between vaccination and onset of disease symptoms suggests a possible causal relationship.
These patients are the first reported cases of Narcolepsy-Cataplexy syndrome related with H1N1 vaccination in Turkey. The first patient had HLA-DQB1*0602.47 and DQB1*03.01 heterozygous loci and the second patient had HLA-DQB1*0602.47 and DQB1*02.01 heterozygous loci. We investigated HLA-DRB1/ DQB1 locus with Polymerase Chain Reaction-Sequence Specific Primer technique. He was also diagnosed as having Narcolepsy-Cataplexy syndrome upon PSG and MSLT. He developed daytime sleepiness 6 months after and cataplexy 8 months after H1N1 vaccination. Our second patient was a 50 year-oldman, who presented to our clinic complaining of sleep paralysis and REM sleep behavior disorder developed 4 months after H1N1 vaccination. Multiple sleep latency test (MSLT) following full-night polysomnography (PSG) showed that the mean sleep latency was 0.6 minutes and all of the naps had sleep-onset REM periods. He also developed hypnopompic hallucinations and nightmares.
After a couple of weeks, weakness of the upper extremities while laughing was added to the clinical picture. Our first patient was a 9-year-old boy, who was referred to our clinic with the complaint of daytime sleepiness developed 1.5 month after H1N1 vaccination. Recently, in European countries, Narcolepsy-Cataplexy syndrome developing following H1N1 vaccination has attracted attention. Narcolepsy-Cataplexy syndrome is a rare sleep disorder related with human leukocyte antigens (HLA-DQB1*0602) caused by the loss of hypothalamic hypocretin/orexin producing neurons.
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