Cataplexy: signs, causes, diagnosis, treatment

  • Cataplexy, or sudden muscle weakness that may feel like fainting, can be triggered by strong emotions.
  • This symptom is not serious and occurs mainly with narcolepsy type 1 – otherwise it is very rare.
  • A doctor can diagnose narcolepsy and prescribe medications to treat cataplexy and other symptoms.

Cataplexy refers to episodes of muscle weakness that typically occur with narcolepsy type 1 – around 75% of people with this sleep disorder have cataplexy.

But in the general population, this symptom is very rare: it affects less than 1% of people who do not have narcolepsy. Other conditions that may involve this uncommon symptom include Wilson’s disease, Niemann-Pick type C disease, and Prader-Willi syndrome.

Cataplexy can feel like fainting, especially if your knees bend under you. You may suddenly feel weak and find it hard to stand or even smile. But the main difference is that you remain conscious, even if your eyes close.

There is no cure for cataplexy, but medication can help you manage it once you get a proper diagnosis.

Read on to learn the main signs of cataplexy and how to treat it.

Signs and symptoms

Cataplexy affects all genders equally. It usually appears before the age of 25, but you can experience it at any age.

“Symptoms are consistent through age, but they vary from person to person, ranging from mild relaxation of facial muscles to drooping,” says Dr. David Culpepper, physician and clinical director at LifeMD.

The main symptoms of cataplexy include:

Sudden muscle weakness due to cataplexy can easily be misdiagnosed as a seizure disorder. But since about 10 percent of people with narcolepsy notice cataplexy as their first symptom, recognizing cataplexy could help you get diagnosed with narcolepsy sooner.

What are the causes?

Experts believe that a hormonal deficiency can cause this symptom. People who suffer from cataplexy typically have lower brain levels of hypocretin, a hormone that helps control your sleep and energy levels.

Low levels of this hormone can cause the same muscle weakness during the day that you would otherwise experience while sleeping.

However, intense emotions like laughter, sadness, fear, and excitement can all trigger cataplexy.

Nancy Mitchell, a registered nurse at the Assisted Living Center, says these emotional triggers vary widely.

“A teenager starting high school or college may experience symptoms due to peer pressure or workload, while young adults may experience uncontrollable muscle twitches when overwhelmed with excitement around their friends and family,” says Mitchell.

So why do intense emotions lead to temporary paralysis? Your brain’s amygdala and prefrontal cortex control your emotions, but these regions also connect to your brain’s paralysis pathways.

Experts believe your brain may associate intense emotions with paralysis, inadvertently causing cataplexy. Studies in mice show that reducing activity in these parts of the brain also reduces cataplexy.

Diagnostic

“Cataplexy mimics the symptoms of seizures and brain tumors, so you should see your clinician to rule out other serious conditions,” says Mitchell.

Tell your doctor if you are fully conscious when you experience muscle weakness. This information can help them find the correct diagnosis, as it is conscious muscle weakness that distinguishes cataplexy from fainting or seizures.

If your doctor suspects cataplexy, they may refer you to a sleep specialist. Cataplexy is usually preceded by excessive daytime sleepiness, so it is often diagnosed alongside narcolepsy at a sleep center.

For a formal diagnosis, your doctor may also ask you to:

  • Keep a sleep diary that tracks your fatigue and other symptoms.
  • Spend the night in a sleep center to have your breathing, muscles and brain activity monitored during sleep using polysomnography.
  • Take several supervised naps at a sleep center so specialists can determine how quickly you fall asleep.

Treatment

“There is currently no cure for narcolepsy or cataplexy,” Culpepper says.

Nevertheless, you have options to manage and cope with the symptoms:

Medication

A combination of prescription drugs is the only treatment.

Commonly prescribed medications include:

Lifestyle changes

Cataplexy can come on quite suddenly, as can fainting. Injuries are rare, but it’s still important to protect yourself from sudden episodes by making sure you can sit down immediately if needed.

“People with cataplexy can try to reduce their risk of injury by arranging their home so that fewer obstacles can cause injury,” says Culpepper.

You’ll likely only have seconds to prepare for an episode, so fall protection for your home in advance can help.

A few other things you can do:

  • Arrange your home and office so that you have immediate access to plush armchairs and sofas.
  • Keep your floor clear of objects you might fall on.
  • Take naps or lie down whenever you feel drowsy or dizzy.
  • Break up long chores or household chores into smaller steps so you can sit down more easily if needed.
  • Sit down before conversations that you think might trigger strong emotional reactions.

Insider’s Takeaways

Cataplexy can feel scary, especially if you suddenly fall down and don’t know why. But this sudden muscle weakness is usually not dangerous if you know your emotional triggers and have a safe place to rest.

A doctor or sleep specialist can diagnose cataplexy and its underlying cause and offer advice on treatment.

Once you have a diagnosis, you can request any accommodations you may need at work and school, such as taking naps if needed and being able to sit up at any time if triggered.

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