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Cataplexy.1/2/2023 While laughter is the most typical trigger, other triggers include happiness, elation, fright, anger, startle, stress and, less frequently, pain and orgasm, although episodes may also occur spontaneously. Keywords: cataplexy, narcolepsy, treatment, sodium oxybate, antidepressants, emerging therapiesĬataplexy: definition and characteristicsĬataplexy is defined as episodes of sudden, transient loss of voluntary muscle tone (usually bilateral, but case reports have identified unilateral cases 1) triggered by strong emotions. Further research and development of therapeutic approaches to cataplexy are needed. Additional possible mechanisms for cataplexy therapy suggested by preliminary research include antagonism of the histamine H 3 autoreceptor with pitolisant and intravenous immunoglobulin therapy for amelioration of the presumed autoimmune-mediated hypocretin/orexin cell loss. Cataplexy. trial#Clinical trial evidence of its efficacy and safety in cataplexy is robust, and it is hypothesized that its therapeutic effects may occur through gamma-aminobutyric acid receptor type B-mediated effects at noradrenergic, dopaminergic, and thalamocortical neurons. The single pharmacotherapy indicated for cataplexy and the guideline-recommended first-line treatment in Europe and the US is sodium oxybate, the sodium salt of gamma-hydroxybutyrate. However, systematic research evidence supporting antidepressants for cataplexy is lacking. Multiple classes of antidepressants have been commonly used off-label for cataplexy in narcolepsy and are suggested for this use in expert consensus guidelines based on traditional practice, case reports, and small trials. Despite these advances, a literature review shows that treatment of cataplexy remains limited. Although the cause of hypocretin/orexin neuron loss in narcolepsy with cataplexy is unknown, an autoimmune etiology is widely hypothesized. It is now generally considered that loss of signaling by hypothalamic hypocretin/orexin-producing neurons plays a key role in the development of cataplexy. Knowledge of the pathophysiology of cataplexy has advanced through study of canine, murine, and human models. Cataplexy is most commonly associated with and considered pathognomonic for narcolepsy, a sleep disorder affecting ~0.05% of the general population. 1Department of Neurology, University of Texas School of Medicine-Houston, Houston 2The Sleep Center at North Cypress Medical Center, Cypress 3Apnix Sleep Diagnostics, Houston 4Neurology and Sleep Medicine Consultants, Houston, TX, USAĪbstract: Cataplexy is defined as episodes of sudden loss of voluntary muscle tone triggered by emotions generally lasting <2 minutes.
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