The clinical features of cataplexy: A questionnaire study in narcolepsy patients with and without hypocretin-1 deficiency

Overeem, Sebastiaan; Nues, Sofie J. van; Zande, Wendy Lm van der; Donjacour, Claire E H M; Mierlo, Petra van; Lammers, Gert Jan

doi:10.1016/j.sleep.2010.05.010

Cited by 125 publications

(85 citation statements)

References 16 publications

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“…1 The most common triggers of cataplexy are laughter (92 % of patients), anger (70 %), and startle reaction (55 %). 2 Muscular weakness that resolves immediately after an attack is a cardinal feature of cataplexy, and often affects the jaw or face rather than the lower limbs. 2 Jerking or twitching of various body parts, including the arms and face, can also occur.…”

Section: Discussionmentioning

confidence: 99%

“…2 Muscular weakness that resolves immediately after an attack is a cardinal feature of cataplexy, and often affects the jaw or face rather than the lower limbs. 2 Jerking or twitching of various body parts, including the arms and face, can also occur. 2 The differential diagnosis of paroxysmal weakness depends on the pattern of symptoms.…”

Section: Discussionmentioning

confidence: 99%

“…2 Jerking or twitching of various body parts, including the arms and face, can also occur. 2 The differential diagnosis of paroxysmal weakness depends on the pattern of symptoms. Transient ischemic attacks and seizures are the major causes of unilateral paroxysmal weakness, followed by hemiplegic migraine and hypoglycemia.…”

Section: Discussionmentioning

confidence: 99%

“…2 Firstline drugs for daytime sleepiness include modafinil and armodafinil, which promote wakefulness by interfering with the dopamine reuptake transporter, and have a lower likelihood of side effects and less potential for abuse than amphetamines. 11 …”

Section: Discussionmentioning

confidence: 99%

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Narcolepsy with Cataplexy in an Elderly Woman

et al. 2015

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A 72-year-old woman was referred for a 15-year history of brief attacks of generalized weakness that occurred when she was tense or startled. During these episodes, she squatted, closed her eyes, and had difficulty speaking, but there was no disturbance of consciousness. The cerebrospinal fluid level of orexin/hypocretin was low (92 ng/ L), leading to a diagnosis of narcolepsy with cataplexy according to the International Classification of Sleep Disorders (ICSD)-2 criteria. Cataplexy should be considered for sudden attacks of weakness lasting less than 2 minutes and with no alteration of consciousness. Measurement of cerebrospinal fluid levels of orexin/hypocretin is recommended when the diagnosis is uncertain. CASE REPORTA 72-year-old woman was referred to our hospital by her primary care doctor for a 15-year history of experiencing Battacks^during which she Blost body control.^These episodes occurred one to ten times on most days, and lasted approximately 1 minute. They occurred when she was tense or startled (e.g. telephone ringing, unexpectedly meeting an acquaintance, or being called into the clinic room by her doctor). During these episodes, she closed her eyes, squatted, and had difficulty speaking. While she could not answer questions, she maintained consciousness and was able to hear the individuals around her and could accurately recall their conversations.The patient reported that she often fell asleep during the day, including during meals, and that she frequently took 15-minute naps that refreshed her temporarily. She occasionally experienced hypnagogic hallucinations, but did not experience sleep paralysis. None of her relatives had similar symptoms. The patient had a 4-year history of well-controlled diabetes, as well as hypertension and hyperlipidemia; she had no complications from her diabetes. Medications included metformin, voglibose, glimepiride, losartan, hydrochlorothiazide, nifedipine, and atorvastatin.The patient had experienced attacks at her physicians' offices, and they had been witnessed by generalists, neurologists, and neurosurgeons, who had variously diagnosed essential tremor, orthostatic hypotension, epilepsy, and psychosomatic disease. A video of an attack was recorded when she visited our clinic (see video link), which showed her experiencing paroxysmal weakness. As can be seen in the video, when the patient was called into the clinic room, she first stood up from her chair and then assumed a half-sitting posture with her head and arms hanging down and her eyes closed. Although she was able to temporarily stand again and walk a few steps, she subsequently became unable to support herself and had to squat down. After 1 minute, she recovered and was able to stand and move normally.Physical exam results, including vital signs, cardiopulmonary, and neurological findings, were normal. Her body mass index was 32 (162 cm, 72 kg). Basic lab values were within normal limits, including hemoglobin A1 C , which was stable at 6.8 %.The patient underwent monitoring during these episodes. Bl...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Narcolepsy with Cataplexy in an Elderly Woman

et al. 2015

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“…The episode duration is short, lasting usually a few seconds and generally less than 1 min. [2][3][4] Cataplexy attacks may cluster, a condition known as cataplectic status, affecting mainly children close to disease onset 4,5 or patients with NT1 after abrupt antidepressant withdrawal. [6][7][8] The clinical diagnosis of cataplexy is often challenging, and sometimes patients with NT1 receive an incorrect diagnosis of epilepsy.…”

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confidence: 99%

Narcolepsy Type 1 and Idiopathic Generalized Epilepsy: Diagnostic and Therapeutic Challenges in Dual Cases

Baiardi

Vandi

Pizza

et al. 2015

Journal of Clinical Sleep Medicine

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Fluctuation of primary motor cortex excitability during cataplexy in narcolepsy

Huang

Qian

Wang

et al. 2019

Ann Clin Transl Neurol

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Objective Cataplexy is a complicated and dynamic process in narcolepsy type 1 ( NT 1) patients. This study aimed to clarify the distinct stages during a cataplectic attack and identify the changes of the primary motor cortex ( PMC ) excitability during these stages. Methods Thirty‐five patients with NT 1 and 29 healthy controls were recruited to this study. Cataplectic stages were distinguished from a cataplectic attack by video‐polysomnogram monitoring. Transcranial magnetic stimulation motor‐evoked potential ( TMS ‐ MEP ) was performed to measure the excitability of PMC during quiet wakefulness, laughter without cataplexy, and each cataplectic stage. Results Based on the video and electromyogram observations, a typical cataplectic attack ( CA ) process is divided into four stages: triggering ( CA 1), resisting ( CA 2), atonic ( CA 3), and recovering stages ( CA 4). Compared with healthy controls, NT 1 patients showed significantly decreased intracortical facilitation during quiet wakefulness. During the laughter stage, both patients and controls showed increased MEP amplitude compared with quiet wakefulness. The MEP amplitude significantly increased even higher in CA 1 and 2, and then dramatically decreased in CA 3 accompanied with prolonged MEP latency compared with the laughter stage and quiet wakefulness. The MEP amplitude and latency gradually recovered during CA 4. Interpretation This study identifies four stages during cataplectic attack and reveals the existence of a resisting stage that might change the process of cataplexy. The fluctuation of MEP amplitude and MEP latency shows a potential participation of PMC and motor control pathway during cataplexy, and the increased MEP amplitude during CA 1 and 2 strongly implies a compensatory mechanism in motor control that may resist or avoid cataplectic attack.

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The clinical features of cataplexy: A questionnaire study in narcolepsy patients with and without hypocretin-1 deficiency

Cited by 125 publications

References 16 publications

Narcolepsy with Cataplexy in an Elderly Woman

Narcolepsy with Cataplexy in an Elderly Woman

Narcolepsy Type 1 and Idiopathic Generalized Epilepsy: Diagnostic and Therapeutic Challenges in Dual Cases

Fluctuation of primary motor cortex excitability during cataplexy in narcolepsy

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