Abstract：
OBJECTIVE: There was more than a 10-fold increase in the incidence of narcolepsy type 1 (NT1) after the H1N1 mass vaccination in 2009/2010 in several countries. NT1 is associated with loss and increase of cell groups in the hypothalamus which may be associated with secondary affected sub-cortical and cortical gray matter. We performed a case-control comparison of MRI-based global and sub-cortical volume and cortical thickness in post-H1N1 NT1 patients compared with controls.
METHODS: We included 54 post-H1N1 NT1 patients (51 with confirmed hypocretin-deficiency; 48 H1N1-vaccinated with Pandemrix®; 39 females, mean age 21.8 ± 11.0 years) and 114 healthy controls (77 females, mean age 23.2 ± 9.0 years). 3T MRI brain scans were obtained, and the T1-weighted MRI data were processed using FreeSurfer. Group differences among three global, 10 sub-cortical volume measures and 34 cortical thickness measures for bilateral brain regions were tested using general linear models with permutation testing.
RESULTS: Patients had significantly thinner brain cortex bilaterally in the temporal poles (Cohen\'s d = 0.68, p = 0.00080), entorhinal cortex (d = 0.60, p = 0.0018) and superior temporal gyrus (d = 0.60, p = 0.0020) compared to healthy controls. The analysis revealed no significant group differences for sub-cortical volumes.
CONCLUSIONS: Post-H1N1(largely Pandemrix®-vaccinated) NT1 patients have significantly thinner cortex in temporal brain regions compared to controls. We speculate that this effect can be partly attributed to the hypothalamic neuronal change in NT1, including loss of function of the widely projecting hypocretin-producing neurons and secondary effects of the abnormal sleep-wake pattern in NT1 or could be specific for post-H1N1 (largely Pandemrix®-vaccinated) NT1 patients.
METHODS: We included 54 post-H1N1 NT1 patients (51 with confirmed hypocretin-deficiency; 48 H1N1-vaccinated with Pandemrix®; 39 females, mean age 21.8 ± 11.0 years) and 114 healthy controls (77 females, mean age 23.2 ± 9.0 years). 3T MRI brain scans were obtained, and the T1-weighted MRI data were processed using FreeSurfer. Group differences among three global, 10 sub-cortical volume measures and 34 cortical thickness measures for bilateral brain regions were tested using general linear models with permutation testing.
RESULTS: Patients had significantly thinner brain cortex bilaterally in the temporal poles (Cohen\'s d = 0.68, p = 0.00080), entorhinal cortex (d = 0.60, p = 0.0018) and superior temporal gyrus (d = 0.60, p = 0.0020) compared to healthy controls. The analysis revealed no significant group differences for sub-cortical volumes.
CONCLUSIONS: Post-H1N1(largely Pandemrix®-vaccinated) NT1 patients have significantly thinner cortex in temporal brain regions compared to controls. We speculate that this effect can be partly attributed to the hypothalamic neuronal change in NT1, including loss of function of the widely projecting hypocretin-producing neurons and secondary effects of the abnormal sleep-wake pattern in NT1 or could be specific for post-H1N1 (largely Pandemrix®-vaccinated) NT1 patients.
摘要：
目的：在2009/2010年期间，几个国家的H1N1大规模疫苗接种后，1型发作性睡病（NT1）的发病率增加了10倍以上。NT1与下丘脑中细胞群的丢失和增加有关，这可能与继发性受影响的皮质下和皮质灰质有关。我们对H1N1NT1后患者与对照组进行了基于MRI的整体和皮质下体积以及皮质厚度的病例对照比较。
方法：我们纳入了54例H1N1NT1后患者（51例确诊为低血糖缺乏；48例接种Pandemrix®的H1N1疫苗；39例女性，平均年龄21.8±11.0岁）和114名健康对照（77名女性，平均年龄23.2±9.0岁)。获得3TMRI脑部扫描，和T1加权MRI数据使用FreeSurfer处理。三个全球性的群体差异，使用具有置换测试的一般线性模型测试了双侧大脑区域的10个皮层下体积测量和34个皮层厚度测量。
结果：患者双侧颞极大脑皮层明显变薄（Cohen'sd=0.68，p=0.00080），与健康对照组相比，内嗅皮层（d=0.60，p=0.0018）和颞上回（d=0.60，p=0.0020）。分析显示皮层下体积没有显着差异。
结论：与对照组相比，H1N1后（主要是Pandemrix®疫苗接种）NT1患者颞脑区域的皮质明显变薄。我们推测，这种作用可部分归因于NT1的下丘脑神经元变化，包括广泛投射的产降血糖素神经元的功能丧失以及NT1中异常睡眠-觉醒模式的继发性作用，或者可能对H1N1后具有特异性（主要是Pandemrix®疫苗接种）NT1患者。
方法：我们纳入了54例H1N1NT1后患者（51例确诊为低血糖缺乏；48例接种Pandemrix®的H1N1疫苗；39例女性，平均年龄21.8±11.0岁）和114名健康对照（77名女性，平均年龄23.2±9.0岁)。获得3TMRI脑部扫描，和T1加权MRI数据使用FreeSurfer处理。三个全球性的群体差异，使用具有置换测试的一般线性模型测试了双侧大脑区域的10个皮层下体积测量和34个皮层厚度测量。
结果：患者双侧颞极大脑皮层明显变薄（Cohen'sd=0.68，p=0.00080），与健康对照组相比，内嗅皮层（d=0.60，p=0.0018）和颞上回（d=0.60，p=0.0020）。分析显示皮层下体积没有显着差异。
结论：与对照组相比，H1N1后（主要是Pandemrix®疫苗接种）NT1患者颞脑区域的皮质明显变薄。我们推测，这种作用可部分归因于NT1的下丘脑神经元变化，包括广泛投射的产降血糖素神经元的功能丧失以及NT1中异常睡眠-觉醒模式的继发性作用，或者可能对H1N1后具有特异性（主要是Pandemrix®疫苗接种）NT1患者。
