Cataplexy

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Cataplexy
ICD-10	G47.4
ICD-9	347
DiseasesDB	16311
MedlinePlus	000802
MeSH	D002385

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Luke Rusowicz-Orazem, B.S.

Overview

Cataplexy is a medical condition which often affects people who have narcolepsy, a disorder whose principal signs are EDS (Excessive Daytime Sleepiness), sleep attacks, sleep paralysis, hypnopompic hallucinations and disturbed night-time sleep. Cataplexy is sometimes confused with epilepsy, where a series of flashes or other stimuli cause superficially similar seizures.

The term cataplexy originates from the Greek kata, meaning down, and plexis, meaning a stroke or seizure.

Causes

Common Causes

• Encephalitis
• Head trauma
• Hydrocephalus
• Hypocretin deficiency
• Hypothalamus lesions
• Narcolepsy
• Neurodegenerative diseases
• Niemann pick disease
• Sleep attacks
• Sleep paralysis

Causes by Organ System

Cardiovascular	Ischemia
Chemical/Poisoning	No underlying causes
Dental	No underlying causes
Dermatologic	No underlying causes
Drug Side Effect	Modafinil, Provigil
Ear Nose Throat	No underlying causes
Endocrine	Niemann pick disease
Environmental	No underlying causes
Gastroenterologic	No underlying causes
Genetic	No underlying causes
Hematologic	No underlying causes
Iatrogenic	No underlying causes
Infectious Disease	No underlying causes
Musculoskeletal/Orthopedic	No underlying causes
Neurologic	Astrocytoma, Encephalitis, Glioblastoma, Glioma, Head trauma, Hydrocephalus, Hypnagogic hallucinations, Hypocretin deficiency, Hypothalamus lesions, Multiple sclerosis, Narcolepsy, Neurodegenerative diseases, Niemann pick disease, Sleep attacks, Sleep paralysis
Nutritional/Metabolic	No underlying causes
Obstetric/Gynecologic	No underlying causes
Oncologic	Astrocytoma, Glioblastoma, Glioma, Paraneoplasia syndrome, Subependynoma, Surgical tumor resection
Ophthalmologic	No underlying causes
Overdose/Toxicity	No underlying causes
Psychiatric	No underlying causes
Pulmonary	No underlying causes
Renal/Electrolyte	No underlying causes
Rheumatology/Immunology/Allergy	No underlying causes
Sexual	No underlying causes
Trauma	Head trauma
Urologic	No underlying causes
Miscellaneous	No underlying causes

Causes in Alphabetical Order

• Astrocytoma
• Encephalitis
• Glioblastoma
• Glioma
• Head trauma
• Hydrocephalus
• Hypnagogic hallucinations
• Hypocretin deficiency
• Hypothalamus lesions
• Ischemia
• Modafinil
• Multiple sclerosis
• Narcolepsy
• Neurodegenerative diseases
• Niemann pick disease
• Paraneoplasia syndrome
• Provigil
• Sleep attacks
• Sleep paralysis
• Subependynoma
• Surgical tumor resection

Presentation

Cataplexy manifests itself as muscular weakness which may range from a barely perceptible slackening of the facial muscles to the dropping of the jaw or head, weakness at the knees, or a total collapse. Usually the speech is slurred, vision is impaired (double vision, inability to focus), but hearing and awareness remain normal. These attacks are triggered by strong emotions such as exhilaration, anger, fear, surprise, orgasm, awe, embarrassment and laughter.

Cataplexy may be partial or complete, affecting a range of muscle groups, from those controlling facial features to (less commonly) those controlling the entire body.

• Arm weakness
• Sagging jaw
• Drooping head
• Slumping of the shoulders
• Slurred speech
• Generalized weakness
• Knee buckling

When cataplexy happens often, or cataplexy attacks make patients fall or drop things, it can have serious affects on normal activities. It can cause accidents and be embarrassing when it happens at work or with friends. For example, a narcoleptic may not pick up a baby because they are afraid they may drop them.

Treatment

Despite its relation to narcolepsy, in most cases, cataplexy must be treated differently and separate medication must be taken. For many years, cataplexy has been treated with tricyclic antidepressants such as imipramine, clomipramine or protriptyline. However these can have unpleasant side-effects and so have been generally replaced by newer drugs such as Effexor, a more recent antidepressant. Xyrem, the brand-name of the compound (sodium)gamma-Hydroxybutyrate GHB, has been shown to treat not only cataplexic attacks, but in narcoleptics, it has also been shown to significantly reduce daytime sleepiness. Monoamine oxidase inhibitors may be used to manage both cataplexy and the REM sleep-onset symptoms of sleep paralysis and hypnagogic hallucinations.

A person's efforts to stave off cataplectic attacks by avoiding these emotions may greatly diminish their lives, and they may become severely restricted emotionally if diagnosis and treatment is not begun as soon as possible.

Diagnosis

Cataplexy in severe cases can cause vital signs to be hard to detect without a continuous auditory pulse oximeter (a well-known heart monitor). As an anecdotal example, one Allison Burchell, a sufferer of severe Cataplexy, has been sent to the morgue three times.

References

Template:Diseases of the nervous system