Characteristics of Cataplexy and Ways to Manage It
Cataplexy is a condition that generates transitory muscular paralysis, diminishing the quality of life of the sufferer. Fortunately, early identification improves the prognosis.
Written by Luis Rodolfo Rojas Gonzalez
Last update: 27 May, 2022
Loss of muscle tone and weakness, conditions linked to neurological and psychiatric disorders such as cataplexy, lead to the sudden loss of control over the musculature. It appears during wakefulness and strong emotions are the most common trigger. Continue reading to find out more about it.
Firstly, Cataplexy is a condition linked to narcolepsy, a chronic pathology characterized by sleep disorders and generalized weakness. Studies affirm that this condition is present in 60 to 90% of narcoleptics.
Causes of cataplexy
Researchers theorize that disturbances in the hypocretin/orexin system, which regulates the sleep-wake cycle, are responsible for the classic symptomatology of narcolepsy. Normal sleep is based on a phase of non-rapid eye movements (NREM) and a phase of rapid eye movements (REM). The body remains temporarily paralyzed during sleep during the latter.
Thus, the sleep dissociation theory suggests that cataplexy results from the intrusion of REM sleep during wakefulness. In this respect, a deficiency of the substance responsible for inhibiting REM sleep, or hypocretin, promotes the appearance of the state of temporary paralysis while a person is awake.
Some research suggests that hypocretin deficiency is due to an autoimmune response mediated by antibodies. Thus, the immune system could be responsible for the degeneration of hypocretin-producing neural pathways.
Intense emotions such as laughter, joy, excitement, surprise, and anger are often the main triggers of cataplexy. Similarly, stress and lack of sleep may worsen it.
Other diseases that may present with cataplexy include:
Secondary narcolepsy
Paraneoplastic encephalitis
Norrie's disease
Newman Pick type C disease
Epilepsy is an underlying disease associated with cataplexy.
Cataplexic episodes occur at the same time as insomnia in most people. Narcoleptics usually first experience this condition during childhood and early adulthood — between the ages of 10 and 25.
Episodes of muscle weakness usually appear suddenly, affecting a specific muscle or muscle group. The person is aware of the condition and everything that's going on around them during these episodes. Cataplexy usually lasts one to two minutes and reverses spontaneously.
Some of the main associated symptoms:
Essential jaw tremor
Lowering of the head
Blinking and abnormal facial grimacing
Ptosis or drooping of the eyelid
Localized or generalized muscle spasms
Difficulty moving the tongue and articulating words
The state of cataplexy can be mild or severe. Similarly, the manifestation of respiratory difficulty, palpitations, profuse sweating, and loss of muscle reflexes is common.
The frequency of presentation is highly variable. Individuals may have one episode per month or 10 per day. In addition, it may worsen over time, manifesting repetitive episodes over several hours. We refer to this condition as paraplegic illness and can occur suddenly.
Diagnosing cataplexy
The diagnosis of cataplexy follows a clinical examination with emphasis on the description of the episodes of muscle weakness. It's tied to daytime insomnia and hallucinations.
In this regard, a doctor may resort to the following tests in order to recognize the cause:
Actigraphy is a test that uses a wristband that measures the sleep-wake pattern to objectively quantify rest duration and schedule. Thus, it can rule out circadian rhythm disorders.
Polysomnography is one of the most commonly used studies in the diagnosis of narcolepsy associated with cataplexy. In fact, research affirms it evaluates the quantity and quality of sleep based on neurophysiological and cardiorespiratory variables.
Multiple sleep latency test consists of a series of four to five scheduled naps. The point is to record sleep characteristics and REM latency. Generally, narcoleptic persons have a REM latency of fewer than 8 minutes.
A hypocretin levels test determines those in the cerebrospinal fluid and is useful in the identification of narcolepsy with cataplexy. Hypocretin values below 110 picograms per milliliter or one-third of normal baseline levels are usually indicative.
Check out the Types and Degrees of Narcolepsy
Currently, there's no definitive cure for cataplexy. However, it's possible to control it with certain medications and reduce the occurrence of episodes of muscle weakness during wakefulness.
The American Association of Sleep Medicine (AASS) suggests the use of the following drugs as part of the therapeutic approach to cataplexy in narcoleptic patients:
Sodium Oxybate is a neuromodulator that acts as a metabolite of gamma-aminobutyric acid (GABA) inhibitory receptors. It increases slow-wave sleep and promotes relief of daytime fatigue and cataplexy. Some side effects include nausea, headache, bedwetting, and morning confusion.
Venlafaxine is a serotonin-norepinephrine reuptake inhibitor that's part of the first-line approach to cataplexy. It's also useful in the management of depression, anxiety disorders, and phobias.
Reboxetine is a potent selective serotonin reuptake inhibitor, recommended as a second line of therapy. Adverse effects include abdominal pain, headache, loss of appetite, and constipation.
Furthermore, European studies suggest the use of tricyclic antidepressants that inhibit the reuptake of noradrenaline and serotonin as a second line of treatment. Similarly, there are non-pharmacological measures one can employ in the management of the condition, such as adequate sleep hygiene and psychotherapy.
Supportive measures for cataplexy complement the unavoidable pharmacological approach.
Ways to prevent cataplexy injuries
Collapse and loss of balance are common in severe cases of cataplexy with generalized involvement of the dorsal and lower limb muscles. Thus, it favors the development of multiple injuries, upon impact with the ground or other blunt objects.
Some recommendations to reduce the risk in people with cataplexy are:
Firstly, apply anger management and stress control methods
Avoid staying for long periods of time near sharp objects or in very high areas
In addition, organize the sleep schedule
Seek support from a chair or companion when experiencing a strong emotion
Don't drive a car or use heavy equipment until you get medical clearance
Lastly, inform family and friends of the condition and its severity
Read about the Diagnosis of Epilepsy in Childhood and its Causes
Lifestyle changes make a good prognosis.
Cataplexy is a condition commonly linked to narcolepsy. Furthermore, its main characteristics are loss of voluntary muscle control while awake. Early identification and treatment offer a better quality of life for those affected.
In this respect, don't hesitate to seek medical attention if you experience generalized muscle weakness or lose control over any muscle group. Finally, health professionals are trained to identify your problem and provide you with the necessary support.
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