SEATTLE, WA—A  case study presented at SLEEP 2015 suggest that an influenza vaccination may have triggered status cataplecticus in the female patient with known narcolepsy.

A 17-year-old female was referred to the Children’s Hospital Colorado and the University of Colorado School of Medicine in Aurora, CO after a diagnosis of narcolepsy with cataplexy by a different sleep physician. Her symptoms of narcolepsy initially appeared about 4 years prior with excessive daytime sleepiness, sleep-related hallucinations, and cataplexy without sleep paralysis.

The teen was positive for DQBI*06:02 allele and scored a 20/24 on her Epworth Sleepiness Scale. An overnight polysomnogram revealed an AHI <1, PLMi 14/hr, sleep latency of four minutes, and sleep efficiency of 92%. The next morning, clinicians observed a mean sleep latency of 2.6 minutes and two out of five sleep onset REM periods.

Four years after her initial cataplexy symptoms, she received a seasonal flu vaccine. Within 20 minutes she began experiencing cataplexy symptoms that persisted for about 24 hours. She had an episodic and instantaneous loss of tone in her lower extremities but did not lose consciousness. 

Status cataplecticus, also known as persistent cataplexy, is a rare form of narcolepsy that has been linked to cessation of venlafaxine or clomipramine, childbirth, and initiation of prazosin.  The patient reports her daytime sleepiness and cataplexy are much better on sodium oxybate, armodafinil, and sertraline.