Journal of Sleep Disorders & Therapy
Open Access

Cataplexy how it is Diagnosed and Treated

Suchi^{* *}Correspondence: Suchi, Department of Medicine and Endocrinology, State University of New York, Downstate Medical Center, Brooklyn, New York, USA, Email:

Author info »

Short Communication

Cataplexy is a condition in which a person's muscles suddenly weaken while they are awake. Cataplexy is a reaction to strong emotions [1]. The triggering events are usually pleasurable, such as laughter, humorous talks, or pleasant surprise. Anger can also provoke episodes, but stress, fear, or physical exertion are infrequent triggers.

Cataplexy attacks can be mild or severe. Momentary sensations of weakness in a few muscles occur in less severe episodes, whereas total loss of voluntary muscular control occurs in more severe episodes. A person collapses and is unable to move or talk during more severe bouts.

Cataplexy, unlike other disorders that involve muscle control loss, such as fainting or seizures, causes patients to remain cognizant and aware. The episodes usually last a few minutes and end on their own.

Narcolepsy-Related Cataplexy

Excessive daytime sleepiness, sleep paralysis, hallucinations, and, in certain cases, cataplexy are all symptoms of narcolepsy. Narcolepsy is divided into two types: type 1 and type 2 [2], which are distinguished by whether or not a person has cataplexy.

Cataplexy is experienced by people with type 1 narcolepsy, but not by people with type 2 narcolepsy. Cataplexy episodes usually start following the beginning of severe sleepiness in persons with type 1 narcolepsy [3]. While both type 1 and type 2 narcolepsy share the word "narcolepsy" in their names, type 1 narcolepsy has a known cause (loss of a neurotransmitter called orexin), whereas type 2 narcolepsy does not.

Causes Cataplexy

While the exact aetiology of cataplexy is unknown, most persons with the condition experience a loss of particular brain cells that generate the hormone orexin (also called hypocretin). Orexin is a hormone that regulates the sleep-wake cycle.

Type 1 narcolepsy research has taught us a lot about the link between orexin (hypocretin) and cataplexy. Several factors may play a role in the decrease of orexin in persons with type 1 narcolepsy, according to this study.

• Autoimmune disorders: The loss of orexin-producing cells may be linked to immune system malfunction. In autoimmune illnesses, the body mistakenly assaults healthy tissue. There's a growing body of evidence that type 1 narcolepsy is caused by the immune system attacking orexin-producing cells [4].

• Family history: While the exact cause of type 1 narcolepsy is unknown, approximately 10% of persons with the disorder have a close relative who has the same symptoms.

• Brain injury: Because of brain traumas, tumours, and other acquired disorders, some persons with type 1 narcolepsy lose orexin-containing brain cells.

Cataplexy Diagnosed

Cataplexy can be difficult to diagnose. There is no formal test for cataplexy, though video recordings of episodes have been suggested as a possible technique [5]. An interview with patients and their family is frequently used to diagnose cataplexy [6].

Doctors are looking for the usual indicators of cataplexy during an interview. A doctor might inquire about how often and how long a person has episodes, as well as what triggers them and which muscles are affected. The doctor may also inquire about the medications you're taking, your sleeping habits, and any other symptoms you're experiencing, such as tiredness throughout the day. A doctor may prescribe an overnight sleep test plus a daytime sleep test if they suspect cataplexy and/or narcolepsy type 1.

References

1. Dauvilliers Y, Arnulf I, Mignot E. (2007). Narcolepsy with cataplexy. Lancet. 2007;369(9560):499–511.
2. Overeem S, van Nues SJ, van der Zande WL, Donjacour CE, van Mierlo P, Lammers GJ. The clinical features of cataplexy: a questionnaire study in narcolepsy patients with and without hypocretin-1 deficiency. Sleep medicine. 2011;12(1):12–18.
3. Okun ML, Lin L, Pelin Z, Hong S, Mignot E. Clinical aspects of narcolepsy-cataplexy across ethnic groups. Sleep. 2002; 25(1): 27–35
4. National Institute of Neurological Disorders and Stroke. Narcolepsy fact sheet. 2020.
5. American Academy of Sleep Medicine. The International Classification of Sleep Disorders – Third Edition (ICSD-3). Darien, IL. (2014)