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Cataplexy with narcolepsy4/25/2023 They go home and talk to their family: “Yeah, that thing you do when you’re laughing.” It’s like, “What thing that I do when I’m laughing?” That’s a symptom you’ve got to keep asking about.ĭr Stephen Stahl is clinical professor of psychiatry and neuroscience at the University of California Riverside, adjunct professor of psychiatry at the University of California San Diego, and honorary fellow in psychiatry at the University of Cambridge. Patients are often not the best historians for this symptom. You might have to ask them about what happened before. If you’re seeing a patient, especially if you’re a psychiatrist seeing a patient or anybody seeing a new patient, if they’ve been on antidepressants for a long time, they may have suppressed the cataplexy. Let me make 2 more points about cataplexy before we move on. Somehow, you’re connecting this “atonia”-lack of tone-at the wrong time when you’re awake and you need your tone.ĭebra Stultz, MD: Right. Some people think it’s because you don’t act out your dreams when you’re paralyzed. ![]() Stephen Stahl, MD, PhD: We normally go into that state when we dream, so we don’t act. What you really have is a normal state in the wrong phase of wakefulness. Then it will be like it must be psychiatric because when they fell they didn’t get hurt. They can feel it coming on, so they don’t fall as often into something. Other times people just hit the floor from fainting. Almost like when people are about to faint, sometimes they’ll hold their arms out before they faint. A lot of times when patients have cataplexy, they can sense it is coming on. Their eyes may move, and that’s why cataplexy is often thought of a psychiatric disorder. They’re aware what’s going on, but they can’t speak. When people do see the cataplexy, they may be confused that the patient is still aware. His eye movements were preserved but had atonia.ĭebra Stultz, MD: Right. He opened up his eyes and said, “Move your eyes left and right.” That’s 1 of the ways to tell it wasn’t a heart attack and he was awake, but he couldn’t move them. On the floor, the guy was completely limp. We were working him up for the possibility of a brain stem tumor. He was a younger guy, so it wasn’t all that credible. He collapsed, and everybody thought it was a cardiac event. That person had disruption of the sleep pathways that caused him to collapse. I don’t see a lot of cataplexy in my own practice, although I did have a case I wrote up a million years ago, last century when I was a neurology resident at UCSF and we had a brain stem tumor. That’s a nice set of descriptions that you had there. That’s interesting, but it’s not helpful because you will miss the more subtle forms. ![]() Stephen Stahl, MD, PhD: Maybe you’ve even seen the Doberman dogs that are bred for cataplexy, and they run across and they collapse, and they get up and they run and collapse again. Most of us have seen these videos in our training. You have the idea that cataplexy doesn’t have to be these dramatic things. Stephen Stahl, MD, PhD: Very fascinating. Any strong emotion that precipitates a muscle weakness is what cataplexy is. Laughter is the most common, but it can occur with anger, frustration, even sexual excitation. Patients have told me, “I can’t wear high heels anymore because I might fall.” It can be any muscle, and it can occur with most any emotion. The most common cataplexy is the knees buckling and that weakness that even your calves can get weak. I had 1 patient with narcolepsy who said she would be working on something stressful at work, and she just drops her pen. You can have shoulder weakness, arm weakness, hand weakness. The patient with pediatric narcolepsy will have a loosening of the jaw, and their tongue will protrude a little.Īfter you’ve seen it for a while, you recognize that it happens with their jaw and have neck weakness, like people bobbing with their head. The jaw weakness is especially common in pediatric cases. I’ve had a couple of ophthalmologists send me narcolepsy patients, and I’m so excited about that. When I’m describing it to patients and I’m talking about the symptoms, I’ll start at the top of the head, with drooping eyelids or even blurred vision. ![]() There was another video of him sitting in the chair, and he would fall to the floor. He would get emotional, and he would fall to the floor. ![]() He was standing with his wife, and she would talk about something. When I was in medical school, and they taught us about narcolepsy-at that time you had to have all the symptoms to get the diagnosis-they showed a video of a man who had narcolepsy. Debra Stultz, MD: We have several other symptoms, but one of the other specific symptoms for narcolepsy is cataplexy.
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