Cataplectic Facies: Clinical Marker in the Diagnosis of Childhood Narcolepsy—Report of Two Cases

Narcolepsy in Children: A Diagnostic and Management Approach

“…23 This happens mostly at the onset of the disease evolution and often without any emotional triggers. 26 Hypnagogic/hypnopompic hallucinations These are relatively common and are reported in nearly two-thirds of the cases. Hypnagogic (sleep-onset) hallucinations are more common than hypnopompic (waking) hallucinations.…”

An under-recognized case of childhood narcolepsy with cataplexy

“…5 Key reasons are the unfamiliarity of the disorder among clinicians, negative test results in early stages, and atypical presentations of the features. 6 The tetrad of symptoms (excessive daytime sleepiness, cataplexy, sleep paralysis, and hypnagogic/hypnopompic hallucinations) occurring together is a rare condition in childhood narcolepsy. 7 If these symptoms are present, they may show variable presentations compared with adults and make it difficult to recognize.…”

“…In addition, cataplexy might be confused with a variety of seizure types. [4][5][6] Therefore, narcolepsy is also important to include in this differential diagnosis.…”

Clinical Characteristics and Burden of Illness in Pediatric Patients with Narcolepsy

“…35,66 Studies in other cohorts have found that EDS and narcolepsy present simultaneously in childhood narcolepsy, and cataplexy symptoms often initially manifest differently in children compared with adults. 18,34,39,61 Features common in children and atypical in adults include hypotonic attacks occurring often without identifiable triggers (spontaneously), with prolonged duration, and prominent, facial and/or jaw and eyelid weakness (ptosis) with spontaneous tongue protrusion ("cataplectic facies") 39,68 often accompanied by neck extension; slurred speech; a complex array of movements, including facial grimacing; and automatic behaviors such as self-scratching and touching. 18,39,61 In particular, cataplectic facies are distinctive to the pediatric population.…”