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01-09-2018 | Original Communication

Coexisting narcolepsy (with and without cataplexy) and multiple sclerosis

Six new cases and a literature review

Authors: Ulf Kallweit, Claudio L. A. Bassetti, Michael Oberholzer, Rolf Fronczek, Mathieu Béguin, Matthias Strub, Gert Jan Lammers

Published in: Journal of Neurology | Issue 9/2018

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.

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Title: Coexisting narcolepsy (with and without cataplexy) and multiple sclerosis
Six new cases and a literature review
Authors: Ulf Kallweit
Claudio L. A. Bassetti
Michael Oberholzer
Rolf Fronczek
Mathieu Béguin
Matthias Strub
Gert Jan Lammers
Publication date: 01-09-2018
Publisher: Springer Berlin Heidelberg
Published in: Journal of Neurology / Issue 9/2018
Print ISSN: 0340-5354
Electronic ISSN: 1432-1459
DOI: https://doi.org/10.1007/s00415-018-8949-x

At a glance: The STEP trials

Springer Medicine

Coexisting narcolepsy (with and without cataplexy) and multiple sclerosis

Six new cases and a literature review

Abstract

Background

Patients and methods

Results

Discussion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Patients and methods

Results

Discussion

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