Cataplexy
Encyclopedia
Cataplexy is a sudden and transient episode of loss of muscle tone, often triggered by emotions. It is a rare disease
(prevalence of fewer than 5 per 10,000 in the community), but affects roughly 70% of people who have narcolepsy
. Cataplexy can also be present as a side effect of SSRI Discontinuation Syndrome
.
The term cataplexy originates from the Greek
κατά (kata, meaning "downwards"), and πληξις (plēxis, meaning "striking" or "hitting" [from plessein meaning "to strike or hit"]).
s 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 emotion
s such as exhilaration, anger
, fear
, surprise
, orgasm
, awe, embarrassment
, and laughter
. A person's efforts to stave off cataplectic attacks by avoiding these emotions may greatly diminish their quality of life, and they may become severely restricted emotionally if diagnosis and treatment is not begun as soon as possible.
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.
When cataplexy happens often, or cataplexy attacks make patients fall or drop things, it can have serious effects on normal activities. It can cause accidents and be embarrassing when it happens at work or with friends. For example, people with cataplexy may not pick up babies because they are afraid they may drop them.
, clomipramine
or protriptyline
. However these can have unpleasant side-effects and so have been generally replaced by newer drugs such as venlafaxine
.
For cataplexy associated with narcolepsy, Xyrem
(sodium oxybate) is often recommended.
Monoamine oxidase inhibitors may be used to manage both cataplexy and the REM sleep-onset symptoms of sleep paralysis and hypnagogic hallucinations.
Rare disease
A rare disease, also referred to as an orphan disease, is any disease that affects a small percentage of the population.Most rare diseases are genetic, and thus are present throughout the person's entire life, even if symptoms do not immediately appear...
(prevalence of fewer than 5 per 10,000 in the community), but affects roughly 70% of people who have narcolepsy
Narcolepsy
Narcolepsy is a chronic sleep disorder, or dyssomnia, characterized by excessive sleepiness and sleep attacks at inappropriate times, such as while at work. People with narcolepsy often experience disturbed nocturnal sleep and an abnormal daytime sleep pattern, which often is confused with insomnia...
. Cataplexy can also be present as a side effect of SSRI Discontinuation Syndrome
SSRI discontinuation syndrome
SSRI discontinuation syndrome, also known as SSRI withdrawal syndrome or SSRI cessation syndrome, is a syndrome that can occur following the interruption, dose reduction, or discontinuation of SSRI or SNRI antidepressant medications...
.
The term cataplexy originates from the Greek
Greek language
Greek is an independent branch of the Indo-European family of languages. Native to the southern Balkans, it has the longest documented history of any Indo-European language, spanning 34 centuries of written records. Its writing system has been the Greek alphabet for the majority of its history;...
κατά (kata, meaning "downwards"), and πληξις (plēxis, meaning "striking" or "hitting" [from plessein meaning "to strike or hit"]).
Presentation
Cataplexy manifests itself as muscular weakness which may range from a barely perceptible slackening of the facial muscleMuscle
Muscle is a contractile tissue of animals and is derived from the mesodermal layer of embryonic germ cells. Muscle cells contain contractile filaments that move past each other and change the size of the cell. They are classified as skeletal, cardiac, or smooth muscles. Their function is to...
s to the dropping of the jaw or head, weakness at the knees, or a total collapse. Usually the speech is slurred, vision
Visual perception
Visual perception is the ability to interpret information and surroundings from the effects of visible light reaching the eye. The resulting perception is also known as eyesight, sight, or vision...
is impaired (double vision, inability to focus), but hearing and awareness
Awareness
Awareness is the state or ability to perceive, to feel, or to be conscious of events, objects or sensory patterns. In this level of consciousness, sense data can be confirmed by an observer without necessarily implying understanding. More broadly, it is the state or quality of being aware of...
remain normal. These attacks are triggered by strong emotion
Emotion
Emotion is a complex psychophysiological experience of an individual's state of mind as interacting with biochemical and environmental influences. In humans, emotion fundamentally involves "physiological arousal, expressive behaviors, and conscious experience." Emotion is associated with mood,...
s such as exhilaration, anger
Anger
Anger is an automatic response to ill treatment. It is the way a person indicates he or she will not tolerate certain types of behaviour. It is a feedback mechanism in which an unpleasant stimulus is met with an unpleasant response....
, fear
Fear
Fear is a distressing negative sensation induced by a perceived threat. It is a basic survival mechanism occurring in response to a specific stimulus, such as pain or the threat of danger...
, surprise
Surprise (emotion)
Surprise is a brief emotional state experienced as the result of an unexpected event. Surprise can have any valence; that is, it can be neutral/moderate, pleasant, or unpleasant. If a person experiences a very powerful or long lasting surprise, it may be considered shock.-Reality...
, orgasm
Orgasm
Orgasm is the peak of the plateau phase of the sexual response cycle, characterized by an intense sensation of pleasure...
, awe, embarrassment
Embarrassment
Embarrassment is an emotional state of intense discomfort with oneself, experienced upon having a socially unacceptable act or condition witnessed by or revealed to others. Usually some amount of loss of honour or dignity is involved, but how much and the type depends on the embarrassing situation...
, and laughter
Laughter
Laughing is a reaction to certain stimuli, fundamentally stress, which serves as an emotional balancing mechanism. Traditionally, it is considered a visual expression of happiness, or an inward feeling of joy. It may ensue from hearing a joke, being tickled, or other stimuli...
. A person's efforts to stave off cataplectic attacks by avoiding these emotions may greatly diminish their quality of life, and they may become severely restricted emotionally if diagnosis and treatment is not begun as soon as possible.
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 effects on normal activities. It can cause accidents and be embarrassing when it happens at work or with friends. For example, people with cataplexy may not pick up babies 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 imipramineImipramine
Imipramine , also known as melipramine, is an antidepressant medication, a tricyclic antidepressant of the dibenzazepine group...
, clomipramine
Clomipramine
Clomipramine is a tricyclic antidepressant . It was developed in the 1960s by the Swiss drug manufacturer Geigy and has been in clinical use worldwide ever since.- Indications :...
or protriptyline
Protriptyline
Protriptyline is a tricyclic antidepressant , specifically a secondary amine, indicated for the treatment of depression and ADHD...
. However these can have unpleasant side-effects and so have been generally replaced by newer drugs such as venlafaxine
Venlafaxine
Venlafaxine is an antidepressant of the serotonin-norepinephrine reuptake inhibitor class. First introduced by Wyeth in 1993, now marketed by Pfizer, it is licensed for the treatment of major depressive disorder , as a treatment for generalized anxiety disorder, and comorbid indications in...
.
For cataplexy associated with narcolepsy, Xyrem
Xyrem
Xyrem is a prescription medication manufactured by Jazz Pharmaceuticals, and is approved by the U.S. Food and Drug Administration for the treatment of cataplexy associated with narcolepsy and Excessive Daytime Sleepiness associated with narcolepsy...
(sodium oxybate) is often recommended.
Monoamine oxidase inhibitors may be used to manage both cataplexy and the REM sleep-onset symptoms of sleep paralysis and hypnagogic hallucinations.