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Remitting Tics and Narcolepsy Overlap Associated with Streptococcal Infection: A Case Report
Author(s) -
Baiardi Simone,
Antelmi Elena,
Filardi Marco,
Pizza Fabio,
Vandi Stefano,
Veggiotti Pierangelo,
Liguori Rocco,
Plazzi Giuseppe
Publication year - 2014
Publication title -
movement disorders clinical practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.754
H-Index - 18
ISSN - 2330-1619
DOI - 10.1002/mdc3.12079
Subject(s) - narcolepsy , cataplexy , tics , medicine , excessive daytime sleepiness , sleep disorder , pediatrics , irritability , psychology , modafinil , psychiatry , insomnia , anxiety
Narcolepsy is a rare hypersomnia of central origin characterized by hypersomnolence, direct transition from wakefulness to rapid eye movement (REM) sleep, and other dissociated states of wake-REM sleep. It is distinguished into narcolepsy type 1 (with cerebrospinal fluid [CSF] hypocretin-1 [hcrt-1] deficiency and/or with cataplexy) and narcolepsy type 2 (without cataplexy and normal CSF hcrt-1). Narcolepsy is associated with human leukocyte antigen (HLA) DQB1*0602 allele, and evidence suggests that a T-cell-mediated autoimmune process may destroy hypothalamic hypocretinergic cells causing narcolepsy. Indeed, streptococcal and H1N1 influenza infections are considered the strongest candidates as environmental triggers. Therefore, narcolepsy could also be considered an autoimmune poststreptococcal disease as with some basal ganglia disorders with acute onset in childhood of motor and behavioral symptoms and episodic course. This case report suggests a common underlying immune-mediated mechanism for both narcolepsy and tics.