Public Defence: Hilde Therese Juvodden Hilde Therese Juvodden at Institute of Clinical Medicine will be defending the thesis "Pathogenesis of Narcolepsy after H1N1-vaccination - a neuroimaging and immunogenetic study" for the degree of PhD (Philosophiae Doctor).

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Foto: Marit Skram, OUS HF

Trial lecture - time and place

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Adjudication committee

  • First opponent: Professor Anne-Marie Landtblom, Uppsala University
  • Second opponent: Senior Lecturer Harald Hrubos-Strøm, University of Oslo
  • Third member and chair of the evaluation committee: Associate Professor Shuo-Wang Qiao, University of Oslo

Chair of defence

Professor Emeritus Torstein Egeland, University of Oslo

Main Supervisor

Stine Knudsen Heier


There was > 10-fold increase of new cases of the sleep disorder, narcolepsy, after the “swine flu-vaccination” (H1N1-vaccination) in 2009/2010 in Norway. Narcolepsy is characterized by unstable regulation of sleep/wake and muscle tonus, leading to sleep attacks and cataplexy (loss of muscle tonus triggered by emotions). Narcolepsy is strongly associated with a loss of sleep/wake and tonus regulating neurons in the brain. This thesis has sought to characterize the pathogenesis of narcolepsy after the H1N1-vaccination through neuroimaging and genetic methods.

The results show that patients have widespread white matter changes in the brain. There are also indications that relatives might represent a group in between healthy controls and patients regarding white matter changes, but this needs to be further explored in future studies. As the study uses an MRI-technique to indirectly measure white matter some caution must be taken in the interpretation.

Further, in an experiment with potentially funny movies, patients were found to have abnormal brain activation. A brain “overactivation” was found when patients watched movies with a potential to be funny, even though they rated the movies as neutral. This meant that patients had similar brain activations regardless of whether they rated the movie as funny or neutral in contrast to their healthy siblings. This indicates that narcolepsy patients have a hypersensitivity to potentially funny stimuli.

Genetic risk and protection were also explored and found to be similar to what is known about the genetic risk of narcolepsy prior to the swine flu-vaccination. This indicates a similar disease mechanism regardless of whether narcolepsy has been developed after a swine flu-vaccination or not.  

In conclusion this thesis gives new insights into narcolepsy after the H1N1-vaccination, regarding the extent of brain abnormalities, the mechanisms behind the clinical important symptom; cataplexy, and genetic risk factors.  

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Published Oct. 7, 2019 12:37 PM - Last modified Oct. 8, 2019 12:18 PM