Several agents are available for treating cataplexy.(2) These can be divided into three groups. During wakefulness, the pontine REM sleep centres are inhibited by noradrenaline and serotonin (5HT) released by activity in the locus coeuruleus and raphe nuclei, but in REM sleep and during cataplexy this inhibition ceases. This causes glycine-mediated inhibition of the alpha motor neurones in the spinal cord with loss of muscle activity. Emotional activity in the limbic system activates the pontine REM sleep centres and nearby regions to increase the activity in the medullary motor centres. The neurological mechanisms underlying cataplexy are complicated. Attention to sleep hygiene, particularly avoiding sleep deprivation, may help, but nevertheless most subjects require drug treatment, usually in the long term. Episodes can sometimes be aborted by tensing the muscles at the onset of an attack. Patients tend to avoid situations in which sudden or intense emotions may be felt and develop coping techniques of controlling the emotions in order to prevent cataplexy. Each episode usually lasts for a few seconds or up to two minutes. It is a specific feature of narcolepsy, a condition characterised by fragmentation and instability of rapid eye movement (REM) sleep, such that the muscle atonia which is normal in REM sleep can appear during wakefulness.Ĭataplexy may be mild and only cause, for instance, twitching of the face or the upper limbs, but it can lead to generalised muscle weakness in which the subject falls to the ground. Hypersomnia also occurs in patients with meningoencephalitis due to African trypanosomiasis (sleeping sickness), which is transmitted by the tsetse fly.Cataplexy is the sudden onset of muscle weakness during wakefulness.(1) It is almost always triggered by sudden or intense emotion, usually laughter. Acute, relatively brief EDS and hypersomnia commonly accompany acute systemic disorders such as influenza. read more can also cause EDS with or without hypersomnia. read more, and seizure disorders Seizure Disorders A seizure is an abnormal, unregulated electrical discharge that occurs within the brain’s cortical gray matter and transiently interrupts normal brain function. Cardinal manifestations are jaundice, coagulopathy, and encephalopathy. read more, hepatic failure Acute Liver Failure Acute liver failure is caused most often by drugs and hepatitis viruses. Principal causes include hyperparathyroidism. read more, hypercalcemia Hypercalcemia Hypercalcemia is a total serum calcium concentration > 10.4 mg/dL (> 2.60 mmol/L) or ionized serum calcium > 5.2 mg/dL (> 1.30 mmol/L). read more, anemia, uremia, hypercapnia Ventilatory Failure Ventilatory failure is a rise in PaCO2 (hypercapnia) that occurs when the respiratory load can no longer be supported by the strength or activity of the system. In patients with diabetes who take insulin or antihyperglycemic. read more, hyperglycemia, hypoglycemia Hypoglycemia Hypoglycemia, or low plasma glucose level can result in sympathetic nervous system stimulation, and central nervous system dysfunction. Signs may include a typical facial appearance, hoarse slow speech, and dry skin. Symptoms include cold intolerance, fatigue, and weight gain. Hypothyroidism Hypothyroidism Hypothyroidism is thyroid hormone deficiency. These disorders include space-occupying lesions affecting the hypothalamus or upper brain stem, increased intracranial pressure, and certain forms of encephalitis. Other disorders that can cause chronic EDS are usually suggested by the history and physical examination brain imaging and blood and urine tests can confirm the diagnosis.
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