Narcolepsy, as a documented disorder, first appeared in medical literature in 1880. Dr. Jean Baptiste Edouard Gélineau published an account of a 38 year old man with a two-year history of narcolepsy. The man experienced up to 200 sleep attacks a day, and also had cataplexy. Interestingly, Dr. Gélineau also describes the patient as having a “nervous, volatile temperament” and “histrionic personality” – an endearment many of us with narcolepsy can probably relate to. The patient also reports having conceived his child “in a moment when the illness came over him.” Cataplexy at orgasm is a phenomenon that has been largely discussed in PWN forums, and has been recently described in medical literature.
Narcolepsy has also been recently linked to influenza. Outbreaks of narcolepsy occurred after the 2009 Swine Flu pandemic and was apparently precipitated by the adjuvant used in the Pandemrix vaccines. However, it has been determined that there is potentially some molecular mimicry occurring between orexin proteins and specific proteins found in influenza itself and the influenza vaccines, confirming that type I narcolepsy is of autoimmune origin. It begs the question, could this first case of narcolepsy have also been precipitated by influenza?
In Dr. Gélineau’s description, the abrupt onset of this particular case led to the suggestion of a potential head trauma in precipitating the disease. This phenomenon is still described today. In this particular report, the patient had been punched in the head and also had a log fall on his head about three years prior; it was determined that these probably did not contribute to his disease in the initial report, though.
What if it was actually precipitated by influenza? The 38 year old man described in the report was first seen by Dr. Gélineau in 1879. Five years prior, he had “suffered acute rheumatism in the joints and Herpes tonsurans at the same time.”
Rhuematism is an inflammatory inflammatory disease that occurs following a Streptococcus pyogenes infection. Importantly, patients with recent onset narcolepsy have demonstrated in increase in anti-streptococcal antibodies. Additionally, influenza infection boosts subsequent Strep pyogenes infection and invasion. For a more detailed perspective on this, check out one of Heidi L.’s most recent posts, H1N1 Flu Virus may cause Narcolepsy via Secondary Infection.
If the patient had a childhood bout of influenza (a likely event, particularly during the pandemic), this might just have been the original trigger of his narcolepsy. To be sure, many people are now discussing respiratory events as predisposing factors in their own narcolepsy. Just check out how many times sinusitis is listed on this thread. Below is a timeline of documented events for that first patient.
So, could the influenza virus and Strep infection have a played a role in the first case of narcolepsy? Maybe, but maybe not. Share your opinions below!