An increased incidence of narcolepsy in children was detected in Scandinavian countries where pandemic H1N1 influenza ASO3-adjuvanted vaccine was used. A campaign of vaccination against pandemic H1N1 influenza was implemented in France using both ASO3-adjuvanted and non-adjuvanted vaccines. As part of a study considering all-type narcolepsy, we investigated the association between H1N1 vaccination and narcolepsy with cataplexy in children and adults compared with matched controls; and compared the phenotype of narcolepsy with cataplexy according to exposure to the H1N1 vaccination. Patients with narcolepsy-cataplexy were included from 14 expert centres in France. Date of diagnosis constituted the index date. Validation of cases was performed by independent experts using the Brighton collaboration criteria. Up to four controls were individually matched to cases according to age, gender and geographic location. A structured telephone interview was performed to collect information on medical history, past infections and vaccinations. Eighty-five cases with narcolepsy-cataplexy were included; 23 being further excluded regarding eligibility criteria. Of the 62 eligible cases, 59 (64% males, 57.6% children) could be matched with 135 control subjects. H1N1 vaccination was associated with narcolepsy-cataplexy with an odds ratio of 6.5 (2.1-19.9) in subjects aged<18 years, and 4.7 (1.6-13.9) in those aged 18 and over. Sensitivity analyses considering date of referral for diagnosis or the date of onset of symptoms as the index date gave similar results, as did analyses focusing only on exposure to ASO3-adjuvanted vaccine. Slight differences were found when comparing cases with narcolepsy-cataplexy exposed to H1N1 vaccination (n=32; mostly AS03-adjuvanted vaccine, n=28) to non-exposed cases (n=30), including shorter delay of diagnosis and a higher number of sleep onset rapid eye movement periods for exposed cases. No difference was found regarding history of infections. In this sub-analysis, H1N1 vaccination was strongly associated with an increased risk of narcolepsy-cataplexy in both children and adults in France. Even if, as in every observational study, the possibility that some biases participated in the association cannot be completely ruled out, the associations appeared robust to sensitivity analyses, and a specific analysis focusing on ASO3-adjuvanted vaccine found similar increase.

We report 11 patients with the locked in syndrome (LIS). The functional outcome was good in four patients with notable motor recovery, but motor deficit remained seriously disturbed in seven patients. All of the patients regained some distal control of finger and toe movements, often allowing functional use of a digital switch. The independence thereby gained is worthwhile, in some patients allowing environment control, communication by means of a computer, and electric wheelchair ambulation. When motor recovery occurs, the progression is disto-proximal with dramatic axial hypotonia. In five patients clinical insomnia was noted and polysomnography showed a reduction of REM sleep. The implications of systems other than the pyramidal tracts in the physiopathology of LIS are discussed.

No abstract

Summary: Automatic sleep EEG analysis was performed on infants from 2 to 11 months of age. Partial power spectra of 1>, e, Ct, and 131 bands were studied as function of sleep stages, age, and time of the night. 131' Ct, and 1> power spectra are significantly lower in paradoxical sleep (PS) than in quiet sleep (QS) whatever the age; but theta is lower in PS than in QS only after 5 months of age. 1>, e, and Ct power increase with age in QS. Only 1> and e are greater in the first half of the night than in the second half. 131 power does not differ significantly in stages 2 and 3 of QS, during the course of the night or as a function of age. Thus 1>, e, Ct may be the best spectral parameters for the maturation of quiet sleep EEGs during the first year of life. Key Words: Automatic analysis-Sleep EEG-Infants.We have previously developed and reported a system of automatic computerized analysis of sleep in infants (1,2), which is valid for full-term infants aged 2-11 months. U sing data from these subjects we studied the development of different EEG frequency bands as a function of sleep stage and course of the night during the first year of life. SUBJECTS AND METHODSTwenty infants younger than 5 months of age and 23 infants aged 5 -11 months were recorded during sleep (Table O. The younger group was recorded during the day (morning sleep), the older group during the first half of the night. Eighteen other infants aged 3-11 months had all-night recordings. These 61 full-term infants were either control subjects, with no serious neurological or medical pathology, receiving no medication, or siblings of infants who had died of Sudden Infant Death Syndrome (SIDS). Sterman et aI. (3) have found only a few minor differences in SIDS siblings as compared with normal subjects at 4 and 8 weeks of age. All of the infants in our study were older than 8 weeks of age, and no differences were found by Sterman et al. in these older babies. Data from the 18 children who had full-night recordings were used for a com-

No abstract