In the past, the onset of narcolepsy was believed to be relatively rare during childhood. Narcolepsy with cataplexy has therefore been primarily described in adult patients, years after onset, with a long established history of narcolepsy. More recently, however, increased awareness has led to reduced diagnostic delays and a flurry of scientific publications on this topic. Recent studies suggest that H1N1/seasonal influenza or vaccination may trigger narcolepsy in pre-pubertal children.
Childhood narcolepsy, besides the typical constellation of symptoms of adulthood narcolepsy, may present with specific features that have never been described so far in adults, that include severe motor abnormalities (more severe cataplexy, generalized weakness, wide-based gait, and a typical facial involvement), obesity, and precocious puberty. This group of young patients requires a careful multi-step diagnostic investigation and prompt pharmacological and behavioural treatment, considering the dramatic scholar and social impact of narcolepsy, the close association between childhood and future adulthood obesity, and the auxological (i.e. low adult height) and psychological consequences of precocious puberty.
Cataplexy in children may appear as a diversity of facial expressions