Ambulatory video-EEG-EMG monitoring and analysis during cataplexy in narcolepsy

Abstract

Objective To comprehensively analyze the clinical and electroneurophysiological characteristics during the process of cataplexy by dynamic video?EEG?EMG monitoring.  Methods Six narcolepsy type 1 patients with typical cataplexy were enrolled and 2 of them were diagnosed as status cataplecticus. All patients underwent polysomnography (PSG) and daytime Multiple Sleep Latency Test (MSLT) to clarify the diagnosis. Cataplexy was triggered by emotional stimulus and recorded under dynamic video-EEG-EMG monitoring. EEG characteristics during cataplexy were further compared and analyzed. Objective To comprehensively analyze the clinical and electroneurophysiological characteristics during the process of cataplexy by dynamic video-EEG-EMG monitoring. Methods Six narcolepsy type 1 patients with typical cataplexy were enrolled and 2 of them were diagnosed as status cataplecticus. All patients underwent polysomnography (PSG) and daytime Multiple Sleep Latency Test (MSLT) to clarify the diagnosis. Cataplexy was triggered by emotional stimulus and recorded under dynamic video-EEG-EMG monitoring. EEG characteristics during cataplexy were further compared and analyzed.  Results Fourteen cataplectic attacks in 6 patients were recorded. According to the clinical and video- EMG characteristics, cataplectic attack was divided into 4 stages, including triggering phase (CA1), resisting phase (CA2), atonic phase (CA3) and recovering phase (CA4). EEG frequency and amplitude varied from one stage to another and hypersynchronous paroxysmal theta (HSPT) was observed in early resisting phase (CA2), which was supposed to be a distinctive EEG characteristic during the onset of cataplexy.  Conclusions Generalized cataplectic  ttack contain 4 stages, which indicate a complicated and dynamic process in clinical and electroneurophysiology. Moreover, it's highly possible that HSPT during resisting phase (CA2) is critical in the mechanism of cataplexy.

DOI: 10.3969/j.issn.1672-6731.2017.09.006