Increased incidence of pediatric narcolepsy following the 2009 H1N1 pandemic: a report from the pediatric working group of the sleep research network.

This study was aimed to evaluate the yearly incidence of pediatric narcolepsy prior to and following the 2009 H1N1 pandemic and to evaluate seasonal patterns of narcolepsy onset and associations with H1N1 influenza infection in the United States. This was a multicenter retrospective study with prospective follow-up. Participants were recruited from members of the Pediatric Working Group of the Sleep Research Network including 22 sites across the United States. The main outcomes were monthly and yearly incident cases of childhood narcolepsy in the United States, and its relationship to historical H1N1 influenza data. A total of 950 participants were included in the analysis; 487 participants were male (51.3%). The mean age at onset of excessive daytime sleepiness (EDS) was 9.6  ±â€… 3.9 years. Significant trend changes in pediatric narcolepsy incidence based on EDS onset (p  <  .0001) occurred over the 1998-2016 period, peaking in 2010, reflecting a 1.6-fold increase in narcolepsy incidence. In addition, there was significant seasonal variation in narcolepsy incident cases, with increased cases in spring (p  <  .05). Cross-correlation analysis demonstrated a significant correlation between monthly H1N1 infection and monthly narcolepsy incident cases (p  =  .397, p  <  .0001) with a lag time of 8 months. We conclude that there is a significant increase in pediatric narcolepsy incidence after the 2009 H1N1 pandemic in the United States. However, the magnitude of increase is lower than reported in European countries and in China. The temporal correlation between monthly H1N1 infection and monthly narcolepsy incidence, suggests that H1N1 infection may be a contributing factor to the increased pediatric narcolepsy incidence after the 2009 H1N1 pandemics.

Electroencephalogram (EEG) duration needed to detect abnormalities in angelman syndrome: is 1 hour of overnight recording sufficient?

Approximately, 90% of patients with Angelman syndrome present with epileptic seizures. Obtaining an electroencephalogram (EEG) with sleep improves the chances of detecting ictal, interictal, and benign abnormal rhythms in Angelman syndrome. However, electroencephalograms, even when obtained during sleep, can be challenging in this population because of tactile sensitivities as well as anxiety related to a novel environment. We tested the hypothesis that 1 hour of sleep on an electroencephalogram would provide as much information as an entire night of electroencephalogram recording, yet more than a routine electroencephalogram conducted during the day. Overnight polysomnograms were collected in 14 children with Angelman syndrome seen at Vanderbilt University. All patients who obtained sleep within the first hour of the overnight electroencephalogram had interictal discharges recorded. Our results show that when sleep is obtained, a 1-hour electroencephalogram yields just as much information as recording an entire night.

Gabapentin shows promise in treating refractory insomnia in children.

Insomnia is prevalent in pediatrics, particularly in those with neurodevelopmental disorders. Gabapentin has shown promise in treating insomnia in adults. The purpose of our study was to review our experience with using gabapentin to treat insomnia in children. We identified 23 children, seen by the authors in our Pediatric Sleep Clinic from January 2009 to March 2012. The mean age was 7.2 years and 70% were male. The majority (87%) had been given diagnoses of neurodevelopmental or neuropsychiatric disorders. All parents received education in sleep behavioral interventions. The majority of children (70%) had both sleep-onset and sleep maintenance insomnia. The average starting dose of gabapentin was 5 mg/kg every bedtime and the maximal dose was 15 mg/kg every bedtime. At follow-up, improved sleep was noted in 78% of children. Adverse effects were noted in 6 children.

Predictors of a nondiagnostic epilepsy monitoring study and yield of repeat study.

OBJECTIVE: Failure to record typical events during long-term video/EEG monitoring (LTM) leaves the diagnosis uncertain. The purpose of this study was to analyze predictors of an initial nondiagnostic LTM study and to evaluate the yield of a repeat study. METHODS: We reviewed all adult LTM studies performed at Vanderbilt University from January 2004 to June 2008. We identified 150 patients with no typical events on LTM and matched them with consecutive controls with typical events. We compared patient demographics, epilepsy risk factors, history of antiepileptic use/failures, and prior EEG and MRI results. RESULTS: Of 2397 LTM studies, 380 (15.8%) failed to record typical events. Absence of epilepsy risk factors and normal outpatient EEG predicted this outcome. A repeat LTM study was successful in 18 of 45 patients (42%). CONCLUSION: The prediction of a nondiagnostic LTM can help to reduce the cost of investigating spells of unknown nature.