Cataplexy and Narcolepsy Basics

There are several narcolepsy symptoms and cataplexy is among the most common.   About seventy precent of people who suffer from narcolepsy also report cataplexy as one of their symptoms.   Cataplexy is a condition that although rare, is serious and disabling.  There is no none cure for narcolepsy or cataplexy. But there are treatments that can lessen the frequency and severity of the episodes.

The most common symptom of narcolepsy is cataplexy. When narcolepsy and cataplexy are together, it has its own biological markers that set it apart from narcolepsy without cataplexy. In “Narcolepsy, A clinical Guide” by Meeta Goswami, the predisposition to narcolepsy is looked at in a cross disciplinary fashion with both genetic studies and environmental factors getting equal scrutiny.  Goswami explains that as many advances have been made in recent years in the understanding of narcolepsy and that “in international classifications, narcolepsy with and without cataplexy are now two different diagnostic entries.”

Narcolepsy Diagnosis

Narcolepsy is a chronic sleep disorder; People who have a chronic sleep disorder like narcolepsy have problems sleeping. This nervous system disorder is characterized by the inability to control sleep cycles, extreme daytime sleepiness and a tendency to fall asleep at inappropriate times, like while driving or walking.  Although there are times when an attack is more likely, like after meals, times of impaired health or during high stress situations, a narcoleptic episode can happen at any time.  The disorder itself is not fatal, however, falling asleep while operating Machinery can be. For this reason, Narcolepsy sufferers often seek to control their disorder with drugs and behavior modifications, like scheduled short daytime naps and night sleep insomnia medication.

Cataplexy as narcolepsy Symptom

Experts recognize cataplexy as sign of narcolepsy.  Cataplexy is when a person has a sudden loss of muscle control and becomes weak. Cataplexy attacks are usually triggered by the act of laughter and extreme emotions.  Vigorous laughter is perhaps the most common trigger for a cataplectic attack.  There are several degrees a person can experience cataplexy.  A mild version of the symptom is when just the face goes slack or the eyelids droop.  This can happen for as little as a few seconds.  In extreme cases, control over the entire body is lost and can last for several minutes.  Unlike with plain narcolepsy, Cataplexy is experienced while completely awake, and alert.  So although they may be completely limp, they are aware of everything that is going on around them. This is what makes cataplexy frightening, especially the first time it is experienced.  A similar symptom is experienced in nighttime hours as sleep paralysis.

Protein Deficiency

No one knows what causes narcolepsy, but recent data indicates that the reduction of the Protein, Hypocretin-1 in the hypothalamus may be the cause of cataplexy in narcoleptic patients. A study was conducted in a sleep center in Brazil by Dr. F Coelho, by testing the spinal fluids of narcolepsy patients. It confirms that a reduction Hypocretin-1 is at least a positive biomarker for cataplexy. Patients without Cataplexy did not show reduced Hypocretin-1 levels. This makes it an effective biomarker for Cataplexy but not for Narcolepsy.

Autoimmune Disease Implications

It is well known that trauma can bring on both Narcolepsy and Narcolepsy with Cataplexy. Goswami states that in the genetics studies, there is a suggestion of possible autoimmune basis for the disease when cataplexy is present and hypocretin is deficient, because of the hypocretin cell destruction.  If this proves to be true, then scientists will have a new direction to look and new treatment options to explore.  Other Autoimmune diseases include Multiple Sclerosis and Rheumatoid Arthritis.

Cataplexy and Narcolepsy Symptoms in Children

Cataplexy and narcolepsy signs that develop in school age children are very uncommon and are usually misdiagnosed due to cataplexy diagnosis currently being based at 100% specific on medical history. The impact narcolepsy can have on a child’s life can be devastating. E.D.S. or excessive daytime sleepiness can cause sleep attacks at unusual periods throughout the day and is commonly linked to cataplexy. The child experiencing this will lose control of his or her muscle functions while being awake. This is usually triggered by laughter and the end result is a fall, which can cause physical harm.

There are several narcolepsy signs and cataplexy is only one. Sleepwalking, for instance is a common symptom. Sleep paralysis is another symptom that is often reported. This can be a horribly frightening experience for children, as they are totally aware of their surroundings, but are unable to move or speak. Other symptoms that have been noted are depression of various ranges, obesity and sleep disturbances in which the child may not be able to distinguish reality from dreams.

Treatment for narcolepsy in children is a highly demanding effort, which includes medication as well as non-medical treatment. Correct diagnosis is paramount for children to gain benefits from treatment. The medicines include sodium oxybate, stimulants and antidepressants. The extra treatments include scheduled napping, environmental adjustments and understanding. This strategy can help children who suffer from narcolepsy to attain a meaningful life.

Narcolepsy/Cataplexy Studies

Narcolepsy has been extensively studied, but the exact cause remains a mystery. It has been suggested that excessive daytime sleepiness is a genetic factor, but narcolepsy is rarely found in relatives. Narcolepsy studies point to disorders of the cerebral pathways that control a person’s ability to stay awake or asleep.

Cataplexy, although defined, is not very precise by that definition; meaning that the distinction between typical and atypical cataplexy is not well recorded. Recent studies have been aimed at finding a more distinct definition for cataplexy as well as grading it by levels of severity. The patients included in the study were those with recorded cataplexy histories and hypocretin-1 deficiencies. A questionnaire containing items that covered a wide range of cataplexy symptoms, including triggers, duration, associated aspects and limitation in a person’s daily life, was given to these patients.

The results placed 60% of the patients with spontaneous cataplectic attacks, with 45% of these patients having both partial and complete cataplectic attacks. Of the patients as a whole, only 15% had symptoms lasting more than 2 minutes. Of triggers, laughing ranked lower than anger as a whole, with laughing hysterically triggering more attacks, which showed that intensity of certain emotional states has a direct impact on cataplexy. Of all the muscles affected during cataplectic attacks the jaw and facial muscles showed a higher rate of involvement in partial attacks.


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