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Huang B, Xu T, Wang Z, Chen K, Zhang J, Zhao Z, Zhuang J, Wu H. The clinical characteristics of cataplectic attack in narcolepsy type 1. Sleep Med 2019; 77:261-269. [PMID: 31607435 DOI: 10.1016/j.sleep.2019.03.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 03/19/2019] [Accepted: 03/20/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Cataplexy is a pathognomonic symptom of narcolepsy type 1. This study was conducted to clarify the clinical characteristics of cataplexy by staging, and to further analyse the correlations of clinical features and cataplectic stages in patients with narcolepsy type 1 (NT1). METHODS We experimentally triggered patients with NT1 into cataplexy while under video-polysomnography (v-PSG) monitoring in the sleep lab. The most serious cataplectic attack from each patient was analysed. Each cataplectic episode was segmented into four stages according to the v-PSG. Correlations were analysed between cataplectic stages in pairs, and between cataplectic stages and other clinical features. RESULTS We observed 81 cataplectic episodes in 21 patients with diverse triggers, including humorous or exciting videos, tickling, recalling horrible memories and exercising. Nine patients (43%) went through complete cataplectic attacks while the others experienced partial attacks. Four cataplectic stages (ie, triggering, resisting, atonic, and recovering) were identified according to clinical and electromyograms characteristics. Resisting stage is predominant (56.4%) in cataplexy, while atonic stage is most related with the total duration of cataplexy. The Epworth Sleepiness Scale score (ESS) has a positive correlation with the total duration of cataplexy. Both duration of cataplexy and ESS score are negatively correlated with disease course. However, medication history seems have no influence on either cataplexy duration or ESS score. CONCLUSION Four-stage segmentation shows the dynamic process of the cataplectic attack, which is different from the traditional classification of complete or partial cataplexy. Resisting stage is necessary for every cataplexy and might reflect the compensation mechanism, while atonic stage may be omitted in some patients. The severity of narcolepsy reduces with the extension of natural course regardless of medication history.
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Affiliation(s)
- Bei Huang
- Department of Neurology, Changzheng Hospital, The Second Medical University of Chinese PLA, Shanghai, China; Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region of China
| | - Tao Xu
- Department of Neurology, Changzheng Hospital, The Second Medical University of Chinese PLA, Shanghai, China
| | - Zongwen Wang
- Department of Neurology, Changzheng Hospital, The Second Medical University of Chinese PLA, Shanghai, China
| | - Kun Chen
- Department of Neurology, Changzheng Hospital, The Second Medical University of Chinese PLA, Shanghai, China
| | - Jihui Zhang
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region of China
| | - Zhongxin Zhao
- Department of Neurology, Changzheng Hospital, The Second Medical University of Chinese PLA, Shanghai, China
| | - Jianhua Zhuang
- Department of Neurology, Changzheng Hospital, The Second Medical University of Chinese PLA, Shanghai, China.
| | - Huijuan Wu
- Department of Neurology, Changzheng Hospital, The Second Medical University of Chinese PLA, Shanghai, China.
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Vaudano AE, Pizza F, Talami F, Plazzi G, Meletti S. The neuronal network of laughing in young patients with untreated narcolepsy. Neurology 2019; 92:e504-e515. [PMID: 30635496 DOI: 10.1212/wnl.0000000000006853] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 09/28/2018] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To investigate the neuronal correlates of spontaneous laughter in drug-naive pediatric patients with narcolepsy type I (NT1) compared to healthy controls by means of blood oxygen level-dependent (BOLD) MRI. METHODS Twenty-one children/adolescents with recent onset of NT1 and 21 age- and sex-matched healthy controls were studied with fMRI while viewing funny videos using a naturalistic paradigm. Whole-brain hemodynamic correlates of spontaneous laughter were investigated in each group and compared by use of appropriate second-level general linear model analyses. If recorded, cataplexy events were treated as the effect of no interest at the single-participant level. Correlations analyses between these contrasts and behavioral findings were performed. RESULTS Emotion-induced laughter occurred in 16 patients (294 events) and 21 controls (357 events). In controls, laughter-related BOLD increases involved a widespread cortical and subcortical network including the bilateral motor and premotor areas, cingulated cortex, insula, and amygdala. In NT1, laughter induced BOLD signal increments in the motor cortex, right thalamus, and left subthalamic nucleus/zona incerta (STN/ZI). STN/ZI and thalamic changes were significantly higher during fMRI sessions with laughter without cataplexy compared to sessions in which laughter was associated with cataplexy. CONCLUSION Laughter expression in individuals with NT1 involves different brain circuits compared to controls by means of overactivation of cortical and subcortical regions belonging to the volitional control of laughter. The activation of the STN/ZI region observed predominantly in patients with NT1 during laugh episodes without cataplexy suggests that the ZI could act to prevent cataplexy.
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Affiliation(s)
- Anna Elisabetta Vaudano
- From the Department of Medicine and Surgery (A.E.V.), Sleep Medicine Center, University of Parma; Department of Biomedical, Metabolic, and Neural Science (A.E.V., S.M.) and Center for Neuroscience and Neurotechnology (A.E.V., S.M.), University of Modena and Reggio Emilia; Department of Biomedical and Neuromotor Sciences (F.P., G.P.), University of Bologna; IRCCS Istituto Delle Scienze Neurologiche di Bologna (F.P., G.P.); and Neurology Unit (F.T., S.M.), OCSAE Azienda Ospedaliero-Universitaria, Modena, Italy.
| | - Fabio Pizza
- From the Department of Medicine and Surgery (A.E.V.), Sleep Medicine Center, University of Parma; Department of Biomedical, Metabolic, and Neural Science (A.E.V., S.M.) and Center for Neuroscience and Neurotechnology (A.E.V., S.M.), University of Modena and Reggio Emilia; Department of Biomedical and Neuromotor Sciences (F.P., G.P.), University of Bologna; IRCCS Istituto Delle Scienze Neurologiche di Bologna (F.P., G.P.); and Neurology Unit (F.T., S.M.), OCSAE Azienda Ospedaliero-Universitaria, Modena, Italy
| | - Francesca Talami
- From the Department of Medicine and Surgery (A.E.V.), Sleep Medicine Center, University of Parma; Department of Biomedical, Metabolic, and Neural Science (A.E.V., S.M.) and Center for Neuroscience and Neurotechnology (A.E.V., S.M.), University of Modena and Reggio Emilia; Department of Biomedical and Neuromotor Sciences (F.P., G.P.), University of Bologna; IRCCS Istituto Delle Scienze Neurologiche di Bologna (F.P., G.P.); and Neurology Unit (F.T., S.M.), OCSAE Azienda Ospedaliero-Universitaria, Modena, Italy
| | - Giuseppe Plazzi
- From the Department of Medicine and Surgery (A.E.V.), Sleep Medicine Center, University of Parma; Department of Biomedical, Metabolic, and Neural Science (A.E.V., S.M.) and Center for Neuroscience and Neurotechnology (A.E.V., S.M.), University of Modena and Reggio Emilia; Department of Biomedical and Neuromotor Sciences (F.P., G.P.), University of Bologna; IRCCS Istituto Delle Scienze Neurologiche di Bologna (F.P., G.P.); and Neurology Unit (F.T., S.M.), OCSAE Azienda Ospedaliero-Universitaria, Modena, Italy
| | - Stefano Meletti
- From the Department of Medicine and Surgery (A.E.V.), Sleep Medicine Center, University of Parma; Department of Biomedical, Metabolic, and Neural Science (A.E.V., S.M.) and Center for Neuroscience and Neurotechnology (A.E.V., S.M.), University of Modena and Reggio Emilia; Department of Biomedical and Neuromotor Sciences (F.P., G.P.), University of Bologna; IRCCS Istituto Delle Scienze Neurologiche di Bologna (F.P., G.P.); and Neurology Unit (F.T., S.M.), OCSAE Azienda Ospedaliero-Universitaria, Modena, Italy
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