Comment on the Letter to the Editor By Dr. Marcus on the Association between Narcolepsy and H1N1 Exposure

Abstract

fectious diseases in some cases for these diseases. Intriguingly, it has long been forgotten that Von Economo’s encephalitis lethargica, a seasonal disease that followed the great 1918 H1N1 flu pandemic, was a very polymorphic disorder at the symp tomatic level. 11 Symptoms included extreme somnolence and ophthalmoplegia (associated with lesions of the posterior hypothalamus and upper brainstem), insomnia and sleep inversion (associated with lesions of the anterior hypothalamus), psychosis, movement disorders (chorea type, as seen in post-streptococcal Sydenham’s Chorea, with lesion of the basal ganglia) and a residual form: post-encephalitis parkinsonism. These recent findings increasingly suggest that narcolepsy may be the tip of the iceberg and that a much broader phenotype involving post-infectious autoimmune pathologies of the brain persists in the population at large. Recent cases of Von Economo’s-like encephalitis have also shown increased ASO titers. 12