Recognizing Cataplexy and Narcolepsy Symptoms

The symptom, Cataplexy and Narcolepsy are often experienced together. Narcolepsy is a chronic sleep disorder characterized primarily by EDS or excessive daily sleepiness. Narcolepsy affects just a small percentage of the population. About 60 to 70 percent, of patients with Narcolepsy show symptoms of cataplexy.

Passing quickly from a state of wakefulness into REM or rapid eye movement sleep or experiencing distinct REM events during the day are considered symptoms of a neurological disorder. Narcolepsy’s cause and origin is still largely unknown, although data from studies conducted on humans and animals suggest that cataplexy and narcolepsy are associated with hypocretin system abnormalities and the loss of active neurons in a person’s hypothalamus.

Cataplexy and Narcolepsy Signs

Usually, excessive daytime sleepiness is the first symptom to appear. It’s characterised by several episodes of sudden sleepiness, lapses and naps during daytime. Although these episodes are most likely to take place in ordinary situations, it may also occur in very unusual situations like when one is eating, walking or even driving; leading to uncontrollable and sudden sleep attacks. The most common symptom of narcolepsy is cataplexy. Generally, it is observed as a dramatic loss of muscle control and tone triggered by sudden strong emotions. Usually, these emotions are positive: surprise, pride, and laughter; however, it may also be negative like anger. Stress, sleepiness, physical fatigue can stimulate factors that can worsen Cataplexy and make the symptom more common.

Cataplexy as a sign of Narcolepsy may be localised, or in worse cases, progressively affect all skeletal muscles; causing a patient to completely collapse on the ground. Commonly affected areas include the face, neck and knees. Fortunately, respiratory muscles cannot be affected. Since Cataplexy as a Narcolepsy symptom can also come in milder forms varying in severity and frequency, diagnosis is sometimes difficult. Mild feelings of weakness, being the sole clinical symptom, may completely pass unnoticed. Probing patients about his/her family members’ experiences involving head drops, sagging facial muscles, weakness of the jaw, slurred speech and knee buckling, is relevant. These narcolepsy and cataplexy symptoms can also vary in duration; ranging from a couple of seconds to minutes. Complete recovery always follows if the person doesn’t injure themselves while affected.

Other Narcolepsy symptoms experienced primarily at night are described in figure 01-02a:

Figure 01-02a – Other Narcolepsy Symptoms Accompanying Cataplexy

Nighttime Cataplexy and Narcolepsy Symptoms

Symptom

Brief Description

Disturbed Nocturnal Sleep

When this symptom is present, it has the tendency to improve in time. It is characterized by the inability or difficulty in having a quality sleep at nighttime, somewhat akin to insomnia. This narcolepsy and cataplexy symptom was underestimated not so long ago, although it is now recognized by most doctors as a major indication of the disorder in patients.

 

Hypnagogic  Hallucinations

This narcolepsy symptom is characterized by vivid hallucinations that may be auditory, tactile, visual or even as multisensory events. These may contain dreamlike elements and occur in the transition between the state of being asleep and wakefulness. The other way around, hallucinations while awake, are referred to as hypnopompic hallucinations.

 

Sleep Paralysis

This narcolepsy sign appears as the lack of movement capability during the same transitions as when the hypnagogic hallucinations occur.

 

 

Effect on a Person’s Life

Narcolepsy symptoms and cataplexy have a great impact on a patient’s quality of life. In the United Kingdom, the biggest problem for patients lies in their limited roles caused by physical difficulties. The time that affected people spend on their work is severely limited by the Narcolepsy signs and cataplexy. Even activities of leisure are shortened since patients usually avoid possible embarrassing situations. Narcolepsy and cataplexy also affect the schooling of many patients, hindering concentration; even making simple daily tasks like cleaning, cooking and watching the children very difficult. Furthermore, it’s been discovered that the accumulation of concern and worry due to narcolepsy and cataplexy can prove harmful to emotional health: greater than 50 percent of all subjects suffering from the disorder are suffering from at least a mild case of depression.

Predisposing Factors and Epidemiology

Narcolepsy’s prevalence is approximately an estimated to be 1:2000 of the American population. It may occur at any age, although it usually happens to people between ages 10 and 25. Also, there are slightly more men affected than women (approximately 1.6/1 relative risk). About 1 to 4 percent of the cases involving narcolepsy and cataplexy have a family member that is also affected. Narcolepsy’s running in families typically shows autosomal-dominant inheritance pattern. Although majority of narcoleptics show non-familial or sporadic narcolepsy, genetic factors remain important. A patient’s first degree relative faces a 1 to 2 percent risk of getting narcolepsy and cataplexy himself.

A main factor to narcolepsy and cataplexy comes from biological factors; according to studies, 25 to 31 percent of all monozygotic twins are prone to the disorder. Also, 90 percent of the patients with narcolepsy and cataplexy show undetectable or low concentrations of hypocretin-1-orexin A in their cerebrospinal fluid. Although this feature is generally specific to narcolepsy and cataplexy, it has also been observed in other CNS (central nervous system) pathologies like Guillain-Barre syndrome.

Recent decades of study have allowed scientist to make progress in understanding the narcolepsy symptoms and cataplexy.  They have identified genes strongly associated with the disorder.  Variant genes in the region of chromosome 6 referred to as HLA complex are strongly although not always, associated with Narcolepsy. This region contains related genes believed to regulate immune function.  It is also known that many of the genetic differences believed to be associated with narcolepsy and cataplexy are not sufficient to cause the disorder. There are many other genes besides those in the HLA complex may contribute to the development of narcolepsy.  Groups of neurons (brain cells) in the brain stem, thalamus, central brain and hypothalamus, interact to control sleep. Many different genes control these neurons’ activity making any of the genes capable of making one develop narcolepsy and cataplexy. Doctors can however look for marked genetic variations associated in narcoleptics to help confirm the diagnosis of narcolepsy. Scientists study narcolepsy in dogs as well and have identified a mutation that causes the disorder in Dobermans.

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