Honda M, Honda Y, Uchida S, Miyazaki S, Tokunaga K
Tokyo Metropolitan Matsuzawa Hospital (MH), Tokyo, Japan.
Biol Psychiatry. 2001 Jun 1;49(11):943-7. doi: 10.1016/s0006-3223(01)01090-3.
Among 15 monozygotic twin pairs described in the literature, only four pairs were considered to be concordant. There is no detailed report of HLA-DRB11501/DQB10602 positive monozygotic twins concordant for narcolepsy, with marked difference in the age of onset.
We compared a pair of female narcoleptic twins clinically.
Diagnosis of narcolepsy and monozygosity of the twins were confirmed. The second-born twin demonstrated a typical course of narcolepsy, whereas the first-born twin had a very late onset of recurrent daytime sleep episodes at age 45 and cataplexy at age 50 years, which was apparently triggered by chronic emotional stresses and sleep insufficiency.
The atypical course of narcolepsy in the first-born twin supports the multifactorial model for the development of narcolepsy. It was noted that cataplexy was preceded by sustained polyphasic sleep conditions. Our observation implies that the unaffected co-twins in discordant pairs could develop narcolepsy in stressful situations later in their lives.
在文献中描述的15对同卵双胞胎中，只有4对被认为是一致的。尚无关于发作性睡病一致的HLA - DRB11501/DQB10602阳性同卵双胞胎的详细报告，其发病年龄存在显著差异。
我们对一对患发作性睡病的女性双胞胎进行了临床比较。
确诊为发作性睡病且双胞胎为同卵性。出生较晚的双胞胎表现出典型的发作性睡病病程，而出生较早的双胞胎在45岁时出现复发性日间睡眠发作且发作很晚，50岁时出现猝倒，显然是由慢性情绪压力和睡眠不足引发的。
出生较早的双胞胎发作性睡病的非典型病程支持发作性睡病发病的多因素模型。值得注意的是，猝倒之前存在持续的多相睡眠状态。我们的观察表明，不一致双胞胎对中未受影响的双胞胎在其生命后期的压力情况下可能会患上发作性睡病。
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