101 Potential Immunological Triggers for Central Disorders of Hypersomnolence two people (8.7%) developed narcolepsy type 1 symptoms within one month after their H1N1 influenza vaccination. Disease progression Narcolepsy type 1 progression was also reported concerning immunological events. Six people who already had EDS reported cataplexy development after an immunological event (two people after flu infection, two after pharyngitis, one after an EBV infection and one after H1N1 influenza vaccination). EDS development in people with cataplexy was reported in two people after an immunological event (one person after an EBV infection and one after H1N1 influenza vaccination). Substantial worsening of EDS complaints after an immunological event was reported in one person after H1N1 influenza vaccination. Other life events Multiple other life events before narcolepsy symptom onset (that were not part of the semi-structured clinical interview) were also sporadically reported in the medical records and included traumatic brain injury (N = 3), childbirth (N = 1), increased anti-GAD34 levels (N = 1), human papillomavirus (HPV) vaccination (N = 4), combined diphtheria, pertussis, tetanus, polio and hepatitis A vaccination (N = 1), hepatitis B vaccination (N = 1), combined hepatitis A and B vaccination (N = 1) and unspecified holiday vaccinations (N = 1). Immunological events before narcolepsy type 2 and idiopathic hypersomnia onset Infection and/or influenza vaccination history was known in 71 individuals with narcolepsy type 2 or idiopathic hypersomnia, of whom the infection history was known in 44 (Figure 2A) and the influenza vaccination history in 57 (Figure 2B). Infection and/or influenza vaccination were reported before developing narcolepsy type 2 or idiopathic hypersomnia in 36/71 individuals (50.7%). Among the people with narcolepsy type 2 or idiopathic hypersomnia, there were six individuals who reported an infection and influenza vaccination before onset of their hypersomnolence disorder. These individuals were included in Figure 2 in the group of immunological events closest to their start of EDS (for five people this was an infection). In one person, the infection and influenza vaccination were similarly close to EDS onset and this individual was included in the infection and influenza vaccination groups. The limited group sizes of narcolepsy type 2 and idiopathic hypersomnia do not allow for statistical 4
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