55 Narcolepsy Type 1 2013 Incidence Peak seen in 2013 (i.e. 27/7 = 3.86) recognizable as an outlier in the box plot (Figure 6). Fisher exact test showed that the ratio of children cases over adult cases was 4.15-fold higher in 2013 compared to in other years (p-value = 0.0005, 95% CI: [1.72, 11.53]). Figure 6. The changes of the ratios between children and adult patients from 1995 to 2015. The median of the ratios is 0.88 and the 1st and 3rd quartiles of the boxplot are 0.64 and 1.67, respectively. All tested children/adolescent cases (19/27) with an onset of EDS in 2013 were HLA DQB1*06:02 positive. The majority of these cases (16/25 = 64%, the other 2 patients had missing data of the cataplexy onset) developed cataplexy within 6 months after EDS onset in 2013, and this proportion was 70.6% (24/34, the other 3 patients had missing data of cataplexy onset) in 2010. 72.2% (13/18, the other 9 patients had missing data) of the children cases developed EDS in April–June in 2013 (Figure 7). In 2010, 50% (17/34, the other 3 patients had missing data) of children patients developed EDS in January–March (Figure 7). Taken the data from 2009 to 2010 together, 51% (24/47, the other 6 patients had missing data) patients developed EDS in the 2009–2010 winter (i.e. December 2009 to March 2010) (Figure 7). The ages of the children/adolescent patients with EDS onset in 2010 (11.26 ± 0.78 years, IQR: 6.92–15.83 years) and 2013 (11.25 ± 0.65 years, IQR: 9.46–14.0 years) were not significantly different (Welch two sample t-test, p-value = 0.997). 2
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