A standardized test to document cataplexy

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Objective/Background: Cataplexy is the pathognomonic symptom of narcolepsy type 1 (NT1). Since it is considered difficult to be directly observed or documented by clinicians, its diagnosis relies mainly on history taking. Our study aimed at testing the feasibility of a standardized video recording procedure under emotional stimulation to document cataplexy in the diagnostic work-up of suspected hypersomnia of central origin. Patients/Methods: Two-hundred-eight consecutive patients underwent the diagnostic work-up and reached the final diagnosis of NT1 (n = 133), idiopathic hypersomnia or narcolepsy type 2 (IH/NT2 group, n = 33), or subjective excessive daytime sleepiness (sEDS group, n = 42). All subjects underwent a standardized video recording procedure while watching funny movies selected according to individual preferences, and a technician blind to clinical features reviewed the recordings to identify hypotonic phenomena that were finally confirmed by patients. Results: The video recording under emotional stimulation captured hypotonic phenomena in 72.2%, 9.1% and 4.8% of NT1, IH/NT2, and sEDS subjects (p < 0.0001), respectively. When tested against CSF hypocretin deficiency, the documentation of a hypotonic episode at the test showed an area under the ROC curve of 0.823 ± 0.033 (p < 0.0001). NT1 patients under anticataplectic medications showed less frequently hypotonic episodes than untreated ones (48.0% vs 77.8%, p = 0.003). Conclusions: A standardized video recording procedure under emotional stimulation can help in the characterization of suspected hypersomnia of central origin. Further multi-center studies are warranted to extend the present findings and integrate a shared procedure for the laboratory work-up of narcolepsy.

Original languageEnglish
Pages (from-to)197-204
JournalSleep Medicine
Volume53
DOIs
Publication statusPublished - Jan 2019

Fingerprint

Cataplexy
Video Recording
Disorders of Excessive Somnolence
Narcolepsy
Idiopathic Hypersomnolence
Motion Pictures
ROC Curve
Documentation
Area Under Curve
Narcolepsy 1

Keywords

  • Cataplexy
  • Differential diagnosis
  • Emotional stimulation
  • Narcolepsy
  • Video recording

ASJC Scopus subject areas

  • Medicine(all)

Cite this

A standardized test to document cataplexy. / Vandi, Stefano; Pizza, Fabio; Antelmi, Elena; Neccia, Giulia; Iloti, Martina; Mazzoni, Alice; Avoni, Patrizia; Plazzi, Giuseppe.

In: Sleep Medicine, Vol. 53, 01.2019, p. 197-204.

Research output: Contribution to journalArticle

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abstract = "Objective/Background: Cataplexy is the pathognomonic symptom of narcolepsy type 1 (NT1). Since it is considered difficult to be directly observed or documented by clinicians, its diagnosis relies mainly on history taking. Our study aimed at testing the feasibility of a standardized video recording procedure under emotional stimulation to document cataplexy in the diagnostic work-up of suspected hypersomnia of central origin. Patients/Methods: Two-hundred-eight consecutive patients underwent the diagnostic work-up and reached the final diagnosis of NT1 (n = 133), idiopathic hypersomnia or narcolepsy type 2 (IH/NT2 group, n = 33), or subjective excessive daytime sleepiness (sEDS group, n = 42). All subjects underwent a standardized video recording procedure while watching funny movies selected according to individual preferences, and a technician blind to clinical features reviewed the recordings to identify hypotonic phenomena that were finally confirmed by patients. Results: The video recording under emotional stimulation captured hypotonic phenomena in 72.2{\%}, 9.1{\%} and 4.8{\%} of NT1, IH/NT2, and sEDS subjects (p < 0.0001), respectively. When tested against CSF hypocretin deficiency, the documentation of a hypotonic episode at the test showed an area under the ROC curve of 0.823 ± 0.033 (p < 0.0001). NT1 patients under anticataplectic medications showed less frequently hypotonic episodes than untreated ones (48.0{\%} vs 77.8{\%}, p = 0.003). Conclusions: A standardized video recording procedure under emotional stimulation can help in the characterization of suspected hypersomnia of central origin. Further multi-center studies are warranted to extend the present findings and integrate a shared procedure for the laboratory work-up of narcolepsy.",
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note = "Ricercatori distaccati presso IRCCS a seguito Convenzione esclusiva con Universit{\`a} di Bologna (Vandi Stefano, Pizza Fabio, Antelmi Elena, Avoni Patrizia, Plazzi Giuseppe)",
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AU - Avoni, Patrizia

AU - Plazzi, Giuseppe

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