COVID-19 triggers type 1 narcolepsy in woman in Europe in rare case
Sudden episodes of muscle weakness led to sleep disorder diagnosis
Written by |
COVID-19 triggered type 1 narcolepsy in a patient in Europe in a rare case. (Image from iStock)
A previously healthy 42-year-old woman in Europe developed type 1 narcolepsy with cataplexy — sudden episodes of muscle weakness triggered by emotions — after COVID-19, according to a new report by researchers urging possible checks for sleep disorders in patients who have had such infections.
The team noted that this case was one of three to date reported globally linking COVID-19 to sleep disorders. However, the researchers concluded that “COVID-19 infection may precipitate and possibly initiate narcolepsy type [1] in predisposed individuals” and, thus, should be considered as a potential trigger.
As such, “clinicians should maintain a high index of suspicion for primary sleep disorders in patients with persistent fatigue and hypersomnolence [excessive daytime sleepiness] after COVID-19, as early recognition and targeted treatment markedly improve outcomes,” the researchers wrote.
The trio’s report, “COVID- 19–Induced Narcolepsy Type I With Cataplexy: A Short Report,” was published in the Journal of Sleep Research.
Narcolepsy is a chronic neurological disorder in which the brain has trouble regulating sleep and wakefulness. As a result, people often experience symptoms such as excessive daytime sleepiness, often with sudden sleep attacks. In type 1 narcolepsy, people also experience cataplexy and near-complete loss of nerve cells producing hypocretin, a brain chemical that helps regulate sleep-wake cycles. This is believed to be due to autoimmune attacks in a brain area called the hypothalamus.
Since the pandemic, COVID-19 has been linked to acute and chronic neurological complications. Infection with SARS-CoV-2, the virus that causes COVID-19, may trigger autoimmune conditions, and rare cases of narcolepsy have been reported after infection and vaccination.
Woman twice had COVID-19 infections
Now, researchers in Denmark described the case of a woman who developed type 1 narcolepsy and cataplexy after COVID-19.
“To our knowledge, only two similar cases have been reported worldwide, making this an important contribution to the growing literature on post-COVID neurological sequelae and syndromes,” the team wrote.
The woman was admitted to the hospital in May 2022 following recurrent episodes of sudden loss of muscle tone, according to the researchers.
Her medical history included two confirmed SARS-CoV-2 infections. The first occurred in March 2020 while she was pregnant. She was not vaccinated at that time and experienced fever, muscle pain, and throat inflammation.
She later received two doses of the Pfizer-BioNTech vaccine in November and December 2021, but had a second COVID-19 infection in January 2022. The second infection was milder, with cold-like symptoms and no fever, per the report.
In the months after the second infection, the woman gradually developed muscle weakness and “a sensation of ‘jelly-like’ legs,” per the report. The weakness later spread to her arms, hands, and neck.
Episodes were brief but frequent, and were sometimes accompanied by tremor, blurred vision, and trouble coordinating hand movements. The woman stopped driving because of these symptoms, the team noted.
Sudden loss of muscle tone seen during hospital stay
During a hospital stay in May 2022, clinicians observed repeated episodes of sudden loss of muscle tone in her arms and legs, followed by tremor and neck twitching. Initial tests, including a brain CT scan, were normal, and muscle disease and nerve-muscle transmission disorders were ruled out.
One month prior, in April 2022, she noted that she’d developed excessive daytime sleepiness. In August 2023, at a sleep clinic evaluation, the woman described typical cataplexy, with brief episodes of sudden loss of muscle tone lasting about 30 seconds. These were often triggered by physical exertion or emotions, especially laughter or worry, according to the researchers. She remained conscious during the episodes.
She also reported fragmented sleep, vivid dream-like experiences when falling asleep or waking up, and morning sleep paralysis, in which she was aware but temporarily unable to move or speak. Her neurological examination was normal.
A polysomnography test, which monitors sleep, breathing, eye movements, and brain activity overnight, was conducted in June 2024 after an earlier test was inconclusive. These results showed poor nighttime sleep quality, periodic limb movements, and mild obstructive sleep apnea, or periods when breathing is repeatedly interrupted during sleep.
A multiple sleep latency test, which measures how quickly a person falls asleep during daytime in a quiet environment, also was conducted. It showed a mean sleep latency of about one minute. The researchers noted that she reached rapid eye movement sleep, when dreams are most vivid and intense, every time, a finding that further supported a diagnosis of narcolepsy.
A spinal tap to collect cerebrospinal fluid, which is the fluid surrounding the brain and spinal cord, showed severely reduced hypocretin-1 levels. Still, a brain MRI scan was normal and did not show injury to the hypothalamus.
“Together, criteria for narcolepsy type I with cataplexy were met,” the team wrote.
Woman’s treatment focused on improving wakefulness
After diagnosis, the woman’s treatment focused on improving wakefulness and reducing cataplexy. The treatment strategy included methylphenidate, a central nervous system stimulant, and modafinil, a wake-promoting agent. She was also prescribed the antidepressant venlafaxine.
After treatment, her daytime sleepiness eased and she had fewer episodes of cataplexy, the researchers noted.
Over several months, the woman regained daily energy and functional capacity, resumed social and work-related activities, and joined a job training program, per the report.
Overall, according to the team, this case suggests that COVID-19 infection can potentially trigger type 1 narcolepsy in individuals predisposed to the condition.
“Further studies are warranted to elucidate the immunological mechanisms underlying post-COVID narcolepsy and the secondary development of sleep disorders,” the researchers wrote.
Rachel Nesmith
Unfortunately due to genetic vulnerabilities including the virus (illness) or vaccine are probably far more common than we realize. H1N1 vaccines in the UK have caused several kids to onsett with type1 Narcolepsy in 2009.