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cataplexy

Etiology: - cataplexy is pathognomonic for narcolepsy - related to - narcolepsy - excessive daytime sleepiness - hypnagogic hallucination - sleep paralysis Epidemiology: - present in 70% of patients with narcolepsy Clinical manifestations: 1) generally provoked by laughter or anticipatory emotion 2) sudden loss of muscle strength & muscle tone - due to intrusion of rapid-eye-movement (REM) into wakefulness - no tonic-clonic activity 3) may be unable to move or speak 4) awake, no loss of consciousness 5) no incontinence 6) muscle atonia 7) deep tendon reflexes (DTR) are lost during the episode, but return promptly afterwards 8) some patients become withdrawn or develop a flat affect in attempt to avoid emotional triggers 9) no post-ichtal state 10) victims able to recall entire event Special laboratory: - polysomnography followed by - multiple sleep latency test Differential diagnosis: - syncope associated with loss of consciousness - seizure associated with loss of consciousness Management: 1) gamma-hydroxybutyrate [sodium oxybate] (Xyrem) is treatment of choice [5] 2) tricyclic antidepressants a) clomipramine (Anafranil) 25-75 mg QD b) protriptyline (Vivactil) 5-20 mg QD c) imipramine (Tofranil) 50-75 mg QHS 3) fluoxetine (Prozac) 20-80 mg QD

Related

catatonia narcolepsy

General

psychiatric disease; behavioral disorder chronic mental disorder

References

  1. Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 1038
  2. DeGowin & DeGowin's Diagnostic Examination, 6th edition, RL DeGowin (ed), McGraw Hill, NY 1994, pg 872
  3. Medical Knowledge Self Assessment Program (MKSAP) 11, American College of Physicians, Philadelphia 1998
  4. Harrison's Principles of Internal Medicine, 14th ed. Fauci et al (eds), McGraw-Hill Inc. NY, 1998, pg 122, 155
  5. Morgenthaler TI et al, Practice parameters for the treatment of narcolepsy and other hypersomnias of central origin. Sleep 2007, 30:1705 PMID: 18246980
  6. Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013 - Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022
  7. Pillen S, Pizza F, Dhondt K, Scammell TE, Overeem S. Cataplexy and Its Mimics: Clinical Recognition and Management. Curr Treat Options Neurol. 2017 Jun;19(6):23 PMID: 28478511 Review.