The distinguishing motor features of cataplexy: a study from video-recorded attacks

Fabio Pizza, Elena Antelmi, Stefano Vandi, Stefano Meletti, Roberto Erro, Christian R. Baumann, Kailash P. Bhatia, Yves Dauvilliers, Mark J. Edwards, Alex Iranzo, Sebastiaan Overeem, Michele Tinazzi, Rocco Liguori, Giuseppe Plazzi

Research output: Contribution to journalArticleAcademicpeer-review

20 Citations (Scopus)


Study Objectives: To describe the motor pattern of cataplexy and to determine its phenomenological differences from pseudocataplexy in the differential diagnosis of episodic falls. Methods: We selected 30 video-recorded cataplexy and 21 pseudocataplexy attacks in 17 and 10 patients evaluated for suspected narcolepsy and with final diagnosis of narcolepsy type 1 and conversion disorder, respectively, together with self-reported attacks features, and asked expert neurologists to blindly evaluate the motor features of the attacks. Video documented and self-reported attack features of cataplexy and pseudocataplexy were contrasted. Results: Video-recorded cataplexy can be positively differentiated from pseudocataplexy by the occurrence of facial hypotonia (ptosis, mouth opening, tongue protrusion) intermingled by jerks and grimaces abruptly interrupting laughter behavior (i.e. smile, facial expression) and postural control (head drops, trunk fall) under clear emotional trigger. Facial involvement is present in both partial and generalized cataplexy. Conversely, generalized pseudocataplexy is associated with persistence of deep tendon reflexes during the attack. Self-reported features confirmed the important role of positive emotions (laughter, telling a joke) in triggering the attacks, as well as the more frequent occurrence of partial body involvement in cataplexy compared with pseudocataplexy. Conclusions: Cataplexy is characterized by abrupt facial involvement during laughter behavior. Video recording of suspected cataplexy attacks allows the identification of positive clinical signs useful for diagnosis and, possibly in the future, for severity assessment.

Original languageEnglish
Article numberzsy026
Number of pages9
Issue number5
Early online date7 Feb 2018
Publication statusPublished - 1 May 2018


  • cataplectic facies
  • cataplexy
  • functional neurological symptom disorder
  • narcolepsy
  • pseudocataplexy


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