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Status Cataplecticus after serotonin-norepinephrine reuptake inhibitor (SNRI) withdrawal: case report.
Cataplexy is a manifestation of type I narcolepsy, characterized by a sudden loss of muscle tone, causing sagging of the face, eyelid or jaw, dysarthria, dropping of head, arm or leg weakness, and buckling of knees. It is caused by intense emotions such as anger, happiness or excitement and lasts for a short time, up to two minutes. Consciousness is maintained during the episodes. The Status Cataplecticus is a rare manifestation of cataplexy, with few cases described in literature, in which the attacks are more intense and prolonged. It is usually triggered by the abrupt withdrawal of antidepressant medication.
To describe Status Cataplecticus, a rare manifestation of narcolepsy.
Clinical and complementary evaluation by polysomnography (PSG) and Multiple Sleep Latency Test (MSLT), in a protocol for withdrawal of antidepressant medication, to confirm narcolepsy diagnosis.
We describe a 64-year-old female patient referred to our sleep center due to excessive daytime sleepiness investigation for 12 years. She had a depression diagnosis and had been using SNRI (venlafaxine). Patient complaints are recurrent episodes of involuntary sleep throughout the day with functional impairment in daily activities. She also relates fragmented and non-restorative sleep. She describes frequent episodes of atypical cataplexy, not associated to emotional triggers. There is no report of hallucinations or vivid dreams. The prior investigation included PSG, MSLT and imaging exams with normal results. We decided to start a new investigation with PSG and MLST but in the absence of SNRI in a hospital day admission to control possible adverse effects. The patient presented a Status Cataplecticus after withdrawal of medication characterized by dysarthria, generalized muscle weakness, axial and appendicular drop, abolished tendon reflexes, and sustained consciousness. MLST results confirmed narcolepsy with mean sleep latency of 5.1 minutes and 4 episodes of SOREMP plus 1 SOREMP on the PSG.
The Status Cataplecticus is a rare condition, often described after abrupt withdrawal of antidepressants, instead of the traditional cataplexy triggers. This is due to the decrease in noradrenergic and serotoninergic tone by disinhibition of REM-on neurons. It is important to emphasize the use of appropriate confirmatory tests for narcolepsy diagnosis, such as PSG followed by MSLT, in the absence of medications and confounding elements such as sleep deprivation.
narcolepsy, cataplexy; Status Cataplecticus
Relato de Caso
Ana Paula Assunção Cecilio , Eddy Alberto Betancourt Flores, Andrea Cecilia Toscanini , Rosa Hasan