Pseudocataplexy in narcolepsy with cataplexy

Segment 1. (Patient 1) Cataplectic attack. While joking and being tickled by her mother, initially there was a transient decrease in cephalic muscle tone accompanied by a slight head nodding, the patient stopped laughing, had sudden loss of knee strength, and 2s later she also lost strength in her arms and trunk, falling to the mat a second later. Ten seconds later, after verbal stimulus from the examiner, the patient started to show initial recovery signs, gradually regaining her muscle tone starting distally, being able to obey orders, eventually sitting up and finally regaining speech (full recovery). The episode lasted a total of 37s. There were no evident positive motor phenomena or EEG abnormalities. Segment 2. (Patient 1) Pseudocataplectic attack. While talking to her mother she gradually and slightly intermittently buckled her knees and fell forward ending supported by her hands and forehead. Initially she did not speak, but after 16s she started crying, and she was capable of verbal response. The episode lasted a total of 37s. There were no positive motor phenomena or EEG abnormalities. This was one of the atypical episodes, as identified by the mother. Segment 3. (Patient 2) Pseudocataplectic attack. The video documentation was part of an experiment to assess emotional modulation of startle reflex in NC. A strong startle reaction was triggered by a loud tone and induced anxious feelings in that patient. Segment 4. (Patient 2) While reporting his emotional reaction to the examiner the patient suddenly reclined, his right arm remained flexed to support his head. When the arm was stretched out by the examiner the patient’s head did not drop. His eyes were closed and he remained conscious throughout the episode. He could not speak, but was able to communicate by uttering noises and nodding or shaking his head. He could not move his arms, open his eyes or speak out loud on command. Slight voluntary movements of the left index finger could be observed. After 50s speech improved and the patient could describe that muscle weakness was gradually resolving. Five seconds later he could open his eyes and after 7s he was able to raise his arms.