![]() This is a simple test that differentiates cataplexy from other drop-attacks. ![]() ![]() ![]() The onset of cataplexy is associated with the absence of deep tendon reflexes that comes back with the return of normal muscle tone. Ĭataplexy is rarely observed in an office visit, and even if it does occur, only a trained specialist who is familiar with the condition often notices it. However, the general decrease in cataplectic symptoms with aging may be reversed after the experience of a significant emotional upset, such as a loss of spouse in older subjects. A review of 100 patients with cataplexy at the Stanford Sleep Disorders Clinic (age range 12-20 years) reported that 62 of these patients stopped taking anti-cataplectic medications after 10 years. Cataplectic symptoms in general tend to decrease with age. investigated 51 prepubertal children with narcolepsy in 10 subjects (5 years and younger) cataplexy was the symptom first recognized. It has also been reported past the age of forty. There is a bimodal pattern of age of onset of symptoms either at 15 or 35 years. A survey of 100 cataplectic patients from the Stanford Sleep Disorders Clinic (age range 14-24 years) reported that 93 percent of the attacks lasted less than two minutes, 6 percent reported events lasting up to five minutes, and 0.94 percent reported events lasting longer than five minutes. Cataplexy is considered “typical” when it is always of short duration (< 5 minutes) and triggered by laughing or joking. Attacks can last from a few seconds up to ten minutes, and may occur up to several times per week. Few attacks occur between the hours of 10 pm and 9 am. In a 24-hour period, cataplectic attacks usually occur between the hours of 10 am and 9 pm. Cataplexy also occurs more frequently in times of emotional stress and when patients are deprived of napping while sleepy. “Status cataplecticus” is rare and can be extremely disabling to the individual. Cataplexy may rapidly reoccur repeatedly, giving birth to “status cataplecticus”, and to the “limp man syndrome” as described by Stalh et al. There is an isolated form that involves facial muscles exclusively. However, diaphragmatic paralysis resulting in central apneas has not been reported. A study of 40 cataplectic patients (age range 13-23 years) reported that sagging of the jaw, inclined head, drooping of the shoulders, and transient buckling of the knees were the most common presentations. Patients present with trembling of mesenteric muscles, rictus, dysarthria, head and upper arm drop, and may drop objects held in hands. The more commonly limited cataplectic attacks involve the head and face, neck, upper limb, and more rarely lower limb known as "knee buckling". However, most often patients with postural collapse have the capability to avoid injury because the fall is slow and progressive. A full-blown attack may occur and results in complete muscle paralysis with postural collapse and possible injury. As the attack continues the patient may experience sleepiness, hallucinations, or sleep-onset REM period. The subject is lucid during this attack and it is important to recognize that consciousness is always maintained at the onset of cataplexy. Ī cataplectic attack is sudden in onset and is localized to a specific muscle group or parts of the body. reported that emotions arising from "hearing or telling a joke," "laughing," or "when angry," were most predictive of the loss of muscle function in clear-cut cataplexy. Data from the Stanford University Sleep Disorders Clinic of 200 patients with cataplexy showed that 100 percent of these patients reported laughter as the most common trigger, followed by a feeling of amusement, or surprise with happiness and joy. Positive emotions, specifically laughter, are most predictive of triggering a cataplectic event. Emotions that may trigger attacks include laughter, fear, anger, frustration, annoyance, nervousness, embarrassment, and sadness. The sudden loss of muscle tone in cataplexy is similar to rapid eye movement (REM)-associated muscle atonia during sleep, but it is occurring during wakefulness.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |