A patient who developed narcolepsy and severe psychiatric symptoms after a Pandemrix H1N1 vaccination was given rituximab, and his condition ameliorated dramatically. However, the positive effects of rituximab unfortunately only lasted for 2 months, after which the patient relapsed, and subsequent treatments with rituximab did not produce any results. The study is here: Transient Impact of Rituximab in H1N1 Vaccination-associated Narcolepsy With Severe Psychiatric Symptoms People with narcolepsy have a diminished number of hypocretin-producing cells; hypocretin (aka: orexin) is a neurotransmitter that plays a role in regulating sleep-wake cycles. The evidence points to narcolepsy involving an autoimmune attack on the hypocretin cells, so this is why theoretically rituximab might help. @Jonathan Edwards, would you know how we might explain the fact that rituximab was pretty effective initially, but then mysteriously stopped working?