A video-polygraphic analysis of the cataplectic attack

Objectives and methods: To perform a video-polygraphic analysis of 11 catap lectic attacks in a 39-year-old narcoleptic patient, correlating clinical m anifestations with polygraphic findings. Polygraphic recordings monitored E EG, EMG activity from several cranial, trunk, upper and lower limbs muscles , eye movements, EKG, thoracic respiration. Results: Eleven attacks were recorded, all of them lasting less than 1 min and ending with the fall of the patient to the ground. We identified, based on the video-polygraphic analysis of the episodes, 3 phases: initial phase , characterized essentially by arrest of eye movements and phasic, massive, inhibitory muscular events; falling phase, characterized by a rhythmic pat tern of suppressions and enhancements of muscular activity, leading to the fall; atonic phase, characterized by complete muscle atonia. Six episodes o ut of 11 were associated with bradycardia, that was maximal during the aton ic phase. Conclusions: Analysis of the muscular phenomena that characterize cataplect ic attacks in a standing patient suggests that the cataplectic fall occurs with a pattern that might result from the interaction between neuronal netw orks mediating muscular atonia of REM sleep and neural structures subservin g postural control. (C) 2000 Elsevier Science Ireland Ltd. All rights reser ved.