Research Day
STATUS CATAPLECTICUS: A NIGHT AND DAY SHIFT DIAGNOSIS
Document Type
Abstract
Date
2021
Abstract
Introduction: Narcolepsy is a rare hypothalamic disorder of orexin deficiency characterized by excessive daytime sleepiness, cataplexy, hallucinations, and sleep paralysis. Cataplexy, the only specific symptom of narcolepsy, is a sudden loss of muscle tone with retained consciousness often precipitated by strong emotion. Recurrent cataplexy--status cataplecticus--is described in case reports following withdrawal or interruption of anticataleptic medications. We present the case of a patient who developed status cataplecticus following brief interruption of sodium oxybate and venlafaxine.
Case: A 30-year-old woman with a past medical history of narcolepsy with cataplexy, migraine with brainstem aura, and generalized anxiety disorder presented to the emergency department with one week of recurrent episodes of transient weakness lasting several minutes. On presentation, vital signs were normal with neurologic examination, lab workup, and MRI all unremarkable. Continuous video electroencephalogram captured four back-to-back spells characterized by global loss of muscle tone with unresponsiveness to noxious stimuli and blink-to-threat challenge with intact consciousness. No interictal epileptiform discharges were recorded. Further history revealed brief interruption of sodium oxybate and venlafaxine dosing due to changes in shift work. After restarting the medications, and with diligent adherence, her symptoms resolved without recurrence at one-year follow-up.
Discussion: Sodium oxybate is the only approved medication for cataplexy, however antidepressants including selective serotonin-norepinephrine reuptake inhibitors are commonly prescribed off-label. Upon discontinuation, the decrease in serotonergic and noradrenergic tone is postulated to trigger rebound cataplexy, and rarely status cataplecticus, within one week. Our patient's case highlights the importance of recognizing this rare but reversible complication.