What to Know About Cataplexy (2024)

Cataplexy is a rare medical symptom. It is a sudden and involuntary loss of muscle tone. Cataplexy is typically associated with narcolepsy, a rare disorder that causes hypersomnia (excessive sleepiness) and sudden bouts of sleep. There are also other causes of cataplexy.

Cataplexy can be distressing, and it is usually diagnosed after other, more common conditions have been considered, such as epilepsy. This article will describe the types, symptoms, causes, diagnosis, treatment, and ways of coping with cataplexy.

Cataplexy Symptoms

Cataplexy occurs abruptly and without warning. A key feature of cataplexy is that it does not affect consciousness. This is a distinguishing characteristic that can differentiate cataplexy from a seizure, syncope (fainting), or a psychiatric condition.

An episode of cataplexy may last for seconds at a time. The frequency of episodes can vary, depending on the underlying condition and whether or not it is treated.

Episodes of cataplexy can occur without a trigger, but they can also be preceded by emotional signs, such as laughing, surprise, or extreme and rapid changes in mood.

An episode of cataplexy can look like the following:

• Leaning your neck over
• Suddenly slumping your body
• Dropping something
• Falling to the ground

Causes

Cataplexy occurs with several different medical conditions, the most common of which is narcolepsy type 1.

Cataplexy is associated with a decrease in certain brain cells that produce hypocretin, also known as orexin, a hormone that’s involved in maintaining a regular sleep-wake cycle. An autoimmune process in which the immune system attacks the cells in the brain that make hypocretin is considered a possible cause of this cell loss in narcolepsy type 1.

Conditions that can cause cataplexy include:

• Narcolepsy type 1: A sleep disorder that causes sudden episodes of daytime sleep
• Niemann-Pick type C disease: A rare hereditary disease that causes seizures, jerking muscles, difficulty walking, yellowing of the skin (jaundice), and cognitive impairment
• Angelman syndrome: A rare genetic disorder that causes seizures, diminished muscle tone, cognitive impairment, and an unusually happy-appearing demeanor
• Norrie disease: A genetic disease that causes eye defects and blindness in males at or soon after birth
• Prader-Willi syndrome: A genetic disorder that causes physical and behavioral effects, including hyperphagia (excessive eating)
• Medications: Examples include Lactimal (lamotrigine), Clozaril (clozapine), and Xyrem (sodium oxybate, also called gamma hydroxybutyrate), the latter of which is also used to treat cataplexy
• Head trauma: Damage to the pituitary gland and hypothalamus may cause cataplexy

Sometimes cataplexy is the first sign of these conditions, but it usually begins to happen after other symptoms have started to occur.

Diagnosis

The diagnosis of cataplexy involves a medical history and a detailed assessment of symptoms. Sudden loss of muscle tone can occur with several conditions that need to be ruled out before cataplexy is considered the cause.

Other conditions that can cause falls or a loss of muscle tone include:

• Seizures, which usually include loss of consciousness, which is not a characteristic of cataplexy
• Syncope, which usually involves dizziness or a feeling of light-headedness, which are not features of cataplexy
• Muscle weakness, which is not usually as abrupt and intermittent as cataplexy
• Hypoglycemia (low blood sugar), which involves other symptoms, in addition to the loss of muscle tone
• Psychiatric disturbance, which is usually associated with other symptoms, such as anxiety or hallucinations

Diagnostic tests that can be done to help identify the cause of cataplexy are usually directed by the associated symptoms and risk factors.

Tests may include:

• Blood tests: Can measure glucose and electrolyte levels
• Hypocretin level in the cerebrospinal fluid: Is reduced in narcolepsy type 1
• Electroencephalogram (EEG): A brain wave test that detects signs of epilepsy
• Electrocardiogram (ECG or EKG): Records the electrical activity of the heart
• Brain imaging: Can identify evidence of brain damage or traumatic injuries.

Treatment

The treatment of cataplexy can be challenging. People who have recurrent episodes due to a metabolic disorder may experience improvement of the symptom of cataplexy with treatment of the underlying metabolic condition. Treatment for these conditions needs to be maintained throughout life.

Several medications, including the following, are approved by the Food and Drug Administration (FDA) for treating narcolepsy, with or without cataplexy:

• Wakix (pitolisant) is FDA-approved for treating cataplexy and excessive daytime sleepiness in adults who have narcolepsy.
• Xyrem (sodium oxybate) is FDA-approved for treating cataplexy and excessive daytime sleepiness in narcolepsy. According to the FDA, use is tightly restricted due to safety concerns.

Prognosis

The outcome of cataplexy can vary. Many children who have narcolepsy can experience an improvement of the disease and fewer episodes as they reach adolescence or adulthood.

Sometimes cataplexy is a persistent symptom that requires ongoing medical management and lifestyle adjustments.

Living With Cataplexy

If you have episodes of cataplexy, it’s crucial to adapt your lifestyle by putting a focus on safety considerations. Taking medication as prescribed is an important step. You can consider keeping a journal to track your episodes so you and your healthcare provider can see whether your treatment is working.

If your episodes of cataplexy occur intermittently or with certain triggers, you should avoid the following whenever you think you could have an episode:

• Driving
• Ladders
• Operating machinery
• Open flames
• Sharp objects

While it may not be realistic to avoid emotions and stress, if it’s possible, you can try to maintain a sense of predictability so that you can minimize the episodes.

Additionally, you should not drink alcohol or use drugs because these substances can have an unpredictable effect on your episodes.

Summary

Cataplexy is a sudden loss of muscle tone without loss of consciousness. Sometimes it is triggered by strong emotions, such as surprise, fear, or excitement. While cataplexy is rare, narcolepsy type 1 is the most common cause of recurrent episodes of cataplexy. Other causes include certain hereditary metabolic conditions and head trauma.

An evaluation of cataplexy involves ruling out other conditions, such as epilepsy and syncope. Sodium oxybate is approved for treating narcolepsy with cataplexy, and the prognosis can vary. Precautions to avoid injuries are an important part of maintaining safety when living with cataplexy.