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Hipnopompic Cataplexy: Report and Implications of a Case
Dirceu C Valladares-Neto, MauricioVDaker and Emerson T Pereira Jr. Clinica Do Sono, Nova Lima, MG Brazil; HGV-FHEMIG Introduction: Hypnopompic cataplexy is a rare condition, especially when not acompanied by narcolepsy. Herein we present a history of H.S.V., a medicai doctor, 55 years old, with symptoms of cataplexy occuring just when awakening since he was 25. This condition prevented him to work in hospital overnight due to faints. His clinicai picture was not accompanied of any other sleep or psychiatric symptoms. One antidepressant, fluoxetine, well known to make REM latency longer and often used to treat cataplexy, was used in this case with positive results. Methods: H.S.V. initially received orally fluoxetine 20mg/day to treat his cataplexy. Since two months later he continued to have fewer and less intense cataplexies, we en-couraged him to increse his medication to 40 mg/day. Results: After using 40 mg/day of fluoxetine for a period of a month, H.S.V. reported us his cataplexy ceased. He is still symptom free six months later, maintaining the medication. Conclusions: We believe this case of hypnopompic cataplexy can give some help in the study of narcolepsy and re-lated symptoms, as shown below: 1) Cataplexy may differ from sleep paralysis just by the presence of a transitory mus-cle strenght, with the duration as small as one or two sec-onds, specially if it occurs during the awakening process. A more precise definition as well as the differential charactristics of this terms - cataplexy and narcolepsy - is necessary. 2) Since sleep paralysis and cataplexy are both transient states, the first occuring from the sleep/awakening proc-ess.while cataplexy occurs in the opposite direction. It would also be important to study cataplexy triggered during differ-ent leveis of consciousness. 3) Cataplexy and sleep paralysis could be seen as a physiological process opposite to what happens when a person suddently awakens in her way to sleep. In this condition some people, especially when tired, change their muscle tonus quickly for felling or perceiving a lost of muscular control, thus awakening. 4) It seems necessary to combine studies of different reas (genetics, physiol-ogy, neuropsychology, immunology) to better help under-stand the cataplexy and sleep paralysis symptoms. New ap-roaches in this field are underway. Support: FCH - FUMEC Belo Horizonte/Brazil, Clinica do Sono/BH/Brazil, Schering-Plough