Cataplexy may rapidly reoccur repeatedly, giving birth to “status cataplecticus”, and to the “limp man syndrome” as described by Stalh et al. There is an isolated form that involves facial muscles exclusively. However, diaphragmatic paralysis resulting in central apneas has not been reported. A study of 40 cataplectic patients (age range 13-23 years) reported that sagging of the jaw, inclined head, drooping of the shoulders, and transient buckling of the knees were the most common presentations. Patients present with trembling of mesenteric muscles, rictus, dysarthria, head and upper arm drop, and may drop objects held in hands. The more commonly limited cataplectic attacks involve the head and face, neck, upper limb, and more rarely lower limb known as "knee buckling". However, most often patients with postural collapse have the capability to avoid injury because the fall is slow and progressive.
A full-blown attack may occur and results in complete muscle paralysis with postural collapse and possible injury. As the attack continues the patient may experience sleepiness, hallucinations, or sleep-onset REM period. The subject is lucid during this attack and it is important to recognize that consciousness is always maintained at the onset of cataplexy. Ī cataplectic attack is sudden in onset and is localized to a specific muscle group or parts of the body. reported that emotions arising from "hearing or telling a joke," "laughing," or "when angry," were most predictive of the loss of muscle function in clear-cut cataplexy. Data from the Stanford University Sleep Disorders Clinic of 200 patients with cataplexy showed that 100 percent of these patients reported laughter as the most common trigger, followed by a feeling of amusement, or surprise with happiness and joy. Positive emotions, specifically laughter, are most predictive of triggering a cataplectic event.
Emotions that may trigger attacks include laughter, fear, anger, frustration, annoyance, nervousness, embarrassment, and sadness. The sudden loss of muscle tone in cataplexy is similar to rapid eye movement (REM)-associated muscle atonia during sleep, but it is occurring during wakefulness.
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