![]() People with narcolepsy often report feeling easily tired or tired all the time. Excessive daytime sleepiness (EDS)ĮDS is usually the first symptom of narcolepsy. In some cases, excessive daytime sleepiness is the only symptom. The four most common symptoms are: excessive daytime sleepiness, cataplexy, sleep paralysis and hypnagogic hallucinations. Narcolepsy symptoms can appear all at once or they can develop slowly over many years. Some researchers have suggested that a set of genes combines with additional unknown factors in a person's life to cause narcolepsy. Narcolepsy often runs in families, but many people with narcolepsy do not have relatives who are affected. Narcolepsy is not caused by psychiatric or psychological problems. In narcolepsy the lack of muscle tone and the dream experiences occur at inappropriate times. Cataplexy, sleep paralysis, and hypnagogic hallucinations are similar to the loss of muscle tone that accompanies normal dreaming in a stage of sleep called REM. However, narcolepsy appears to be a disorder of the part of the central nervous system that controls sleep and wakefulness. What causes narcolepsy? Although narcolepsy has been thoroughly studied, the exact cause is not known. Although no "cure" for narcolepsy has been found, most children with narcolepsy can lead nearly normal lives if properly treated. While narcolepsy is relatively uncommon, its impact on a child's life can be dramatic and, if not recognized, disabling. Importantly, management also needs to involve sleep hygiene advice, safety measures whenever applicable and guidance with regard to the social sequelae of cataplexy.Ĭataplexy Drop attacks Narcolepsy Pseudocataplexy Sodium oxybate Syncope.Narcolepsy is a sleep disorder that causes symptoms such as excessive daytime sleepiness and, in some cases, "sleep attacks." These "attacks" cause people with narcolepsy to fall asleep at very unusual and sometimes dangerous times (while in the middle of a conversation or driving a car). Symptomatic treatment is possible with antidepressants and sodium oxybate. Over time, these severe symptoms evolve to the milder adult phenotype, and this pattern is crucial to recognize when assessing the outcome of uncontrolled case series with potential treatments such as immunomodulation. ![]() ![]() Cataplexy shows remarkable differences in childhood compared to adults, with profound facial hypotonia and complex active motor phenomena. Currently, the diagnosis of cataplexy is made almost solely on clinical grounds, based on history taking and (home) videos. Childhood narcolepsy, with its profound facial hypotonia, can be confused with neuromuscular disorders, and the active motor phenomenona resemble those found in childhood movement disorders such as Sydenham's chorea. They can be differentiated from cataplexy using thorough history taking, supplemented with (home)video recordings whenever possible. Cataplexy mimics include syncope, epilepsy, hyperekplexia, drop attacks and pseudocataplexy. Next to narcolepsy, cataplexy can sometimes be caused by other diseases, such as Niemann-Pick type C, Prader Willi Syndrome, or lesions in the hypothalamic or pontomedullary region. Moreover, childhood cataplexy differs from the presentation in adults, with a prominent facial involvement, already evident without clear emotional triggers ('cataplectic facies') and 'active' motor phenomena especially of the tongue and perioral muscles. The expression of cataplexy varies widely, from partial episodes affecting only the neck muscles to generalized attacks leading to falls. Although cataplexy is rare, its recognition is important as in most cases, it leads to a diagnosis of narcolepsy, a disorder that still takes a median of 9 years to be diagnosed. This review describes the diagnosis and management of cataplexy: attacks of bilateral loss of muscle tone, triggered by emotions and with preserved consciousness.
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