B became slow and tremulous, with lowering of her head and eyes and flexion of her right arm. A typical event was witnessed (by AZ) on a visit to the clinic. The symptoms were associated with features of panic. The weakness lasted for 20 minutes to several hours, and episodes occurred once every few days. John’s Wort with symptomatic improvement.Ī 59-year-old woman presented with a 4-month problem of “funny turns.” These involved weakness of abrupt onset and forced her to lie down. The eventual DSM-IV diagnosis was major depressive disorder, single episode, mild to moderate, accompanied by episodes of “pseudocataplexy,” involving transient weakness, slowing of thought and action, and sensory disturbance associated with negative thoughts. His human leukocyte antigen (HLA) type was not typical of narcolepsy with cataplexy.

Investigations including renal and liver function, serum calcium, MRI brain scan, EEG, nerve conduction studies, polysomnograpy and multiple sleep latency testing were normal. The initial diagnostic formulation was of narcolepsy with cataplexy with associated clinical depression. Mental state assessment and relevant psychiatric history enumerated signs and symptoms of depression. Neurological examination was unremarkable. At a prior psychiatric interview, he became withdrawn, weak, and sleepy for up to 10 minutes when the discussion touched on negative emotions. His Epworth Sleepiness Scale score was elevated at 15/24 (upper limit of normal 10–11), and he gave a clear history of episodes of sleep paralysis. He was sometimes able to control attacks by diverting his thoughts. Attacks sometimes coincided with a “flood of negative thoughts.” He had never felt that he was dreaming at these times. Sadness evoked by music triggered them occasionally, but laughter had not done so. He recognized that negative thoughts, sometimes triggered by arguments, often preceded the episodes. On one occasion he thought he might have fallen asleep during an episode. The symptoms lasted for several minutes and sometimes for as long as an hour or two. The symptoms developed over the course of at least one minute but generally several minutes. As it did so, his body “slowed” and slumped, so that it was difficult for him to move at all. 3Ī 42-year-old man reported episodes of a tingly, heavy, numb feeling spreading forward gradually from the back of his head.

A similar case was described in the second paper. 2, 3 The patient described in the first paper 2 presented with attacks of weakness resembling cataplexy which proved likely to be psychogenic on a background after a diagnosis of narcolepsy was supported by the results of sleep laboratory investigations. We encountered two previous reports of pseudocataplexy as defined here (episodes resembling cataplexy that are sufficiently close to give rise to a suspicion of this diagnosis which prove on further assessment to have a primarily psychological explanation). We searched using the second group of keywords and then a combination of the first and second.

The key words and phrases used in the search were grouped into (a) depression or affective disorders and (b) pseudocataplexy, psychogenic cataplexy, transient paralysis, or transient weakness. We undertook a systematic literature search in the MEDLINE and Embase electronic databases to see whether a similar phenomenon has been described previously. The principle features of the cases are summarized in Table 1. We describe the clinical features, review the two previous related reports, and place pseudocataplexy in the broader context of related causes of functional weakness. In one case, the episodes of pseudocataplexy were captured during video-telemetry. 1 We describe four patients referred to a neurology clinic with short-lived episodes of weakness, leading in three cases to an explicit suspicion of cataplexy the eventual diagnosis was of psychogenic weakness, often associated with mood disorder. While amusement and laughter are the most frequent triggers, other emotions sometimes induce cataplexy, including exhilaration, anger, fear, surprise, orgasm, awe, and embarrassment. Speech is often slurred however, awareness is invariably preserved. The paralysis may range in severity from a barely perceptible slackening of the facial muscles to the drooping of the jaw or head, weakness at the knees, or collapse to the ground. C ataplexy refers to a state of transient paralysis induced by emotion, particularly laughter, which usually occurs in the context of narcolepsy.

Examples of mild cataplexy