Better biomarkers for childhood narcolepsy-cataplexy
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Narcolepsy is characterized by excessive daytime sleepiness and a tetrad of sleep attacks, cataplexy, hypnogogic/hypnopompic hallucinations, and sleep paralysis.1 In addition, fragmented sleep is also present in up to 90% of persons. The prevalence of narcolepsy is between 20 and 50/100,000, or roughly 1 in 2,000, with the lowest prevalence in Israel and the highest prevalence in Japan.2 A bimodal peak for age at onset occurs, with a maximum rate of onset at 15 years and a second peak at 34 years.3 In children, the peak age is around 9 years. Several studies have shown an increased prevalence of narcolepsy in Europe and Asia after the H1N1 influenza virus pandemic in 2009, and the introduction of the vaccine against it.4 A similar increase, by 2- to 3-fold, in pediatric narcolepsy cases has also been reported in the United States.5
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