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What is Cataplexy narcolepsy syndrome?


Cataplexy is a sudden loss of voluntary muscle tone triggered by strong emotions such as laughter. It is most commonly associated with narcolepsy, a sleep problem that affects between 135,000 to 200000 people across the United States.

Cataplexy narcolepsy occurs during the waking hours. At the time of the mild attack, there may be a barely visible weakness of a muscle, such as drooping of eyelids. The most severe may involve a total collapse of the body.

It is a different condition and sometimes misdiagnosed as a seizure disorder. There is no cure for this condition, but it can be managed with drugs and modification of potential triggers. During the episodes of this, an individual is awake but temporarily paralyzed.

Cataplexy narcolepsy worsens by muscular, emotional fatigue and equally affects males and females. It is linked to narcolepsy and could occur after sudden stopping antidepressant drugs. Sodium oxybate is a USA-approved treatment for this condition.

What do you mean by cataplexy?

Cataplexy is a sudden loss of muscle control, typically on both sides of the body, and gets triggered by unpleasant emotions. Laughter is the most typical trigger of this syndrome, but other triggers may include excitement, happiness, annoyance, fear, stressful event, or surprise.

It is most often associated with narcolepsy, but it can occur with other rare disorders like Niemann-Pick type C and Wilson’s. Occasionally, cataplexy can also be seen in other medical conditions, including multiple sclerosis, stroke, encephalitis, and head injury.

The duration of the cataplexy attack is brief, usually lasting anywhere from a few seconds to a few minutes, generally less than two minutes, followed by a rapid return of normal muscle function and tone.

Like other health conditions that cause a loss of muscle control, such as seizures or fainting, people who experience these problems remain aware and conscious. Cataplexy attacks typically last a couple of minutes and resolve on their own.

Overview of Cataplexy narcolepsy syndrome?

Narcolepsy is a common sleep disorder characterized by excessive daytime sleepiness, hallucination, sleep paralysis, and in some cases, cataplexy. There are two significant types of narcolepsy- type 1 and type 2, differentiated by the person’s experience.

People diagnosed with type 1 narcolepsy experiences episodes of cataplexy narcolepsy syndrome; on the other hand, people with type 2 do not. For individuals suffering from type 2 narcolepsy, cataplexy attacks typically begin after the onset of excessive sleeping.

Both type 1 and type 2 narcolepsy have the name narcolepsy in them. The causes for type 1 are well understood, while the cause of type 2 is not understood.

Primary and secondary cataplexy narcolepsy

The primary and secondary types of cataplexy narcolepsy are type 1 and type 2. Type 1 narcolepsy is used to known as narcolepsy with cataplexy. On the other hand, type 2 narcolepsy is known as narcolepsy without cataplexy.

In some cases, an individual may develop another type of narcolepsy known as secondary narcolepsy. It can occur due to brain injury, specifically the hypothalamus region, which regulates the sleeping cycle.

All types of narcolepsy are caused due to excessive daytime sleepiness. It is the first symptom you will get if you develop this condition. Episodes of excessive daytime sleepiness are sometimes described as sleep attacks. In this condition, you may feel awake and alert one moment, then on the verge of sleeping next.

Every sleep attack may last for a few seconds or several minutes. Experts say about 10 to 25 percent of people suffering from narcolepsy experience other symptoms also.

Type 1 narcolepsy symptoms

In addition to excessive daytime sleepiness, type 1 narcolepsy may also cause other symptoms, including cataplexy, sleep paralysis, insomnia, and hallucination. The presence of cataplexy is the crucial characteristic of type 1 as this symptom does not occur in type 2.

Type 2 narcolepsy symptoms

The type 2 narcolepsy symptoms tend to be less severe than those of type 1. In addition to excessive sleepiness, type 2 narcolepsy also includes symptoms such as sleep paralysis, insomnia, and hallucination.

Type 2 narcolepsy does not usually cause cataplexy.

What are the common causes of cataplexy narcolepsy?

The sleep association of hypothesis recommends that cataplexy narcolepsy is the muscle paralysis that generally occurs during the REM sleep intruding into waking hours. But the exact cause of this condition is still unknown, but a loss of neurons that produces hypocretin is thought to be a significant contributing factor. It is a neurotransmitter that promotes wakefulness within the sleep or the wake cycle.

An individual suffering from cataplexy has been found to have a specific human leukocyte antigen, variations in the T-cell receptor, or dysfunction of the immune system’s responses to separate antigen exposures. It is thought that narcolepsy can be an autoimmune disorder, but some research is needed to prove it.

Research published by the Journal of Clinical Investigation in 2010 stated that the loss of hypocrite auto antigens is caused by the autoimmune response targeting the tribes homolog two auto antigens. This autoimmune response causes two antibodies to form that target and kill the neurons in the brain that produce hypocretin.

The catalectic frequency episodes vary from less than one per year to several days. An individual with cataplexy will experience one or more episodes every week.

Primary symptoms of narcolepsy cataplexy syndrome?

The symptoms of cataplexy narcolepsy include:

Excessive daytime sleepiness

Every patient with this condition experience symptom of excessive daytime sleepiness. Generally, daytime sleepiness interferes with everyday activities such as work, home life, school, and social activities. Although naps during the day may help you feel after and relaxed, tiredness returns within two hours. People are experiencing this symptom report mental cloudiness, lack of concentration and energy, depressed mood, extreme exhaustion, and memory lapses.

Hallucination

Usually, these delusions are vivid and can be frightening. The hallucination symptom can occur just before falling asleep or after waking up. It is mainly visual, but you can feel like you can hear, smell, or taste things. Some examples include seeing an animal or person in the room, floating feelings or sensations of being touched, and gearing voices and alarms.

Sleep paralysis

It is unable to move or speak just before falling asleep or after waking up. Sleep paralysis episodes usually go away after a few seconds to a few minutes.

Disrupted night-time sleep: It is usually described as frequent awakenings. People with symptoms face the problem of waking up many times in the middle of the night.

Cataplexy

It is a sudden loss of muscle strength or tone brought on by strong emotions such as fear, laughter, stress, anger, and surprise. These attacks can occur any time you are awake. It can range from quick buckling of the knees or slackness in the jaw-dropping of eyelids to total body paralysis with collapse.

This symptom usually lasts for a few seconds to several minutes. You remain fully conscious during these attacks, but the rate of attacks ranges from a few in a lifetime to several per day. Although scary, there is no damage from these episodes.

How to diagnose cataplexy narcolepsy?

To diagnose cataplexy narcolepsy is a big challenge. There is no single examination to detect this condition, although it has been suggested that video recordings of episodes can be a helpful tool. Its diagnosis is usually based on interviews with the patients and their families.

In the interview, experts look for the classic signs of cataplexy. They may ask how often an individual experiences the episodes, how long it lasts, which muscle is affected, or triggering events. A health care professional may also ask about the drugs you are taking, sleep routines, or other associated symptoms such as daytime sleepiness.

If your healthcare professional suspects cataplexy narcolepsy type 1, you may order overnight and daytime sleep tests. It may look different in children as compared to adults. Children with this condition often show symptoms in their gait or walking style or suffer from attacks that involve the muscles of the face.

Cataplexy narcolepsy diagnosed in children is not triggered by emotional events. As they grow older, the symptoms get changed to minor cataplexy that usually occurs in adults.

How is cataplexy narcolepsy treated?

There has been no cure for cataplexy narcolepsy till now, but some remedies are available that decrease to manage the symptoms. Your health care professional may recommend a central nervous system stimulant for excessive daytime sleepiness, such as armodafinil or modafinil.

If these drugs do not work well, they may prescribe a stimulant containing Adderall or methylphenidate.

For the treatment of cataplexy narcolepsy, your health care provider may recommend these drugs:

  •  Selective reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors such as venlafaxine or fluoxetine.
  • Tricyclic antidepressants include imipramine, protriptyline, or clomipramine.
  • Central nervous stimulants depressants are also known as oxybate

Your health care provider may also encourage you to practice various lifestyle habits, such as taking short naps in the daytime, maintaining a regular sleep schedule, or other remedies to reduce the symptoms of cataplexy narcolepsy naturally without any medications.

However, some evidence supporting the use of antidepressants for cataplexy is varied. In addition, withdrawal from venlafaxine can potentially cause rebound cataplexy. So, regarding safety, even if you sense the onset of an episode, injury is possible with this condition.

How to cope with cataplexy narcolepsy?

When you experience cataplexy narcolepsy, it can be a frightening experience; episodes are not considered dangerous so long as a person is in a safe place. Many people know when an outbreak occurs, giving them essential time to settle down or lie down. Between episodes, it can be helpful to take steps to ensure that environment is safe for when these cataplexy episodes arise.  

Create a safe environment: Sudden weakness of muscle can make ordinary activities more dangerous. Consult your health care professional or other experts who experience cataplexy to learn how to plan for such attacks. Particular attention should be paid to driving, climbing, or swimming activities.

Talk about your problem with your boss or teachers: School administrators and employers can help make special accommodations for people who experience cataplexy attacks. This accommodation can involve making time for nap breaks, changes in the work or school environment, or allowing work to be done when someone almost feels alert.

Find help: Experiencing cataplexy narcolepsy can be socially isolating and emotionally draining. Talking to others suffering from the condition can help with practical tips and emotional support. Since this condition most often occurs in people suffering from narcolepsy, finding support for narcolepsy can be a helpful initial step.

How can I improve my sleep hygiene?

For some people suffering from cataplexy, lifestyle changes are an essential; aspect of managing the symptoms. There is a clear link between cataplexy and sleep deprivation that has not been established; some patients report that getting enough sleep leads to having reduced episodes.

Improving the sleep cycle is an effortless and effective task to improve health and decrease the risk of sleep loss. It involves increasing habits that can promote sleep and reducing the habits that interfere with your sleep. To improve your sleeping schedule, here are some tips that may help you achieve your goal.

Manage your daytime habits: Activities in the daytime can significantly impact your sleep schedule. Make sure to get regular exercise and natural daylight every day. Also, avoid drinking alcohol or caffeine, smoking, or having large meals before a few hours going to bed.

Establish a night-time sleeping schedule: Before you go to bed for sleeping, give your mind at least 30 to 60 minutes to wind your thoughts and relax your mind. Ensure that you shut down all electronic devices and find a relaxing activity such as reading, taking a bath, or stretching. These exercises may help to relax your nerves and lull you into a night of better sleep.

Conclusion

Cataplexy narcolepsy can interfere with your daily life schedule. It can strain your close relationship as well as your professional life. But, you can manage cataplexy with treatment, lifestyle changes, and improvement in your sleep habits. Once you get it under your control, you can decrease your risk of having an episode of cataplexy attacks while doing something potentially dangerous such as driving.

So, if you start to experience any symptoms of this condition, consult your health care professional immediately for a diagnosis so that you can get early treatment or manage your symptoms.

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