How narcolepsy patients with cataplexy present.

Narcolepsy patients or their caregivers may or may not recognize the presence of cataplexy.^1-2

• The presence of cataplexy can only be established by clinical interview.^1-3
  • Cataplexy attacks may be so subtle that patients do not notice them or consider the sensations to be normal.^1,2,4
  • Partial attacks may be limited to a sort of “fleeting sensations of weakness in the body.”⁴
  • In other cases, patients may be aware of their symptoms and take action to try to prevent or shorten them.^3,4
    • In one study, nearly 57% of patients reported they could sense the approach of an attack and take action to try to prevent or shorten them.³
• Sometimes symptoms are only recognized by experienced observers such as the patient’s partner.^1,4
• It may be helpful to have the patient’s partner participate in the clinical interview.^1,4

Cataplexy can have a distinct presentation in children.⁵

• Cataplexy can present differently in children than in adults, especially in younger patients close to disease onset.⁵
• In children, cataplexy often presents with a prominent facial involvement, called “cataplectic facies,” consisting of⁵:
  • Bilateral ptosis
  • Mouth opening
  • Tongue protrusion
• The facial features of cataplexy may occur without clear emotional triggers.⁵
  • Emotional triggers in children may also be subtle and difficult to detect.

Cataplexy can be triggered by a variety of strong emotions.^1,6,7

• Positive emotions, such as those associated with laughter or humor, are the most frequent and potent triggers.^1,3,6
• Negative emotions, such as those associated with anger, are also quite common.^3,6,7
• The element of surprise, as associated with several situations, is also a frequent factor.^3,6