Cataplexy
The table below summarises the response from a group of subjects with narcolepsy who were asked what were the most common ways in which their cataplexy was triggered. Laughter and anger precipitated cataplexy in almost all the patients.
| No of Positive Responses (n=50) | Situations |
| 47 | Laughter |
| 43 | Anger |
| 35 | Feeling of Amusement |
| 30 | Athletic Activity |
| 28 | Excitement |
| 26 | Elation |
| 25 | Resisting a Sleep Attack |
| 24 | Surprise |
| 22 | Tension |
| 19 | Spontaneous |
| 18 | Attempt at repartee |
| 17 | Response to a call for action |
| 16 | Sexual intercourse |
| 15 | Fear |
| 14 | Embarrassment |
| 11 | Swimming |
| 7 | Yawning |
| 7 | Revulsion |
| 5 | Sighing |
| 1 | Driving an automobile |
(Adapted from Guilleminault C et al Arch Neurol. 1974 31: 255-261.)
Both children and adults need to interact with the patient to learn when and how to help the patient during a cataplectic attack. Family members need to learn when the patient may be in danger, pain, or otherwise need assistance. The patient will usually have individual preferences about whether he or she wants to be touched, supported, assisted, or simply left alone during attacks. In most cases, the patient will prefer to recover spontaneously.
Adult members of the family can benefit from assurances that the attacks are not related to epilepsy and are manifestations of REM sleep intrusion into the waking state.
Full-blown cataplectic attacks can be frightening to family members. Special attention must be given to the emotional impact on the patient's children. Children sometimes interpret the occasional grimaces, erratic body movements, or unintelligible words that may occur during the attack as signs that their parent is in great pain or may die. They may also experience overwhelming feelings of helplessness. Counselling is very important to assist the child with the pain and terror she or he may be feeling.
The family's routine acceptance of the attack can do much to reduce embarrassment when attacks occur in public. The following illustrates how family members can interact during narcoleptic attacks. A woman with narcolepsy was dining in a restaurant with friends and family. During the meal she experienced several attacks. Her daughter was aware of her mother's condition and during each attack she stood behind her mother providing support for the head and shoulders until the attack had passed. Since family members accepted the situation calmly and did only what was necessary to prevent injury, everyone else in the restaurant remained calm. After the first few attacks, the other diners paid no further attention to the incidents.
Communication between family members is very important and can keep cataplectic attacks from being unnecessarily upsetting and disruptive for both the patient and family.