Cataplexy is one of the main symptoms of narcolepsy type 1. It involves sudden and brief muscle weakness that’s triggered by strong emotions, like laughter. It can affect only parts of your body (like your face) or your whole body. Medication can help manage cataplexy.
Cataplexy happens when strong emotions (like laughter, excitement or anger) trigger sudden, brief muscular weakness while you’re awake. It’s one of the main symptoms of narcolepsy. Narcolepsy is a chronic (lifelong) sleep disorder that causes an urge to fall asleep suddenly during the daytime that’s almost impossible to resist. It affects children and adults. Cataplexy is also a symptom of certain very rare genetic conditions.
Muscle weakness in cataplexy episodes can range from mild to severe. For example, you may have weakness in only a few muscles, like those in your face leading to a sagging jaw or mild head drop. In severe cases, you could lose total control of your muscles and collapse. But people remain conscious (awake) during a cataplexy attack, unlike in fainting (syncope) and seizures.
Attacks usually last seconds to a few minutes and instantly go away on their own. The frequency of attacks varies. Some people have several cataplexy attacks a day, while others may have them only a few times a year.
Cataplexy is a symptom of narcolepsy. There are two main types of narcolepsy. Whether or not you have cataplexy separates the two:
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Cataplexy can be difficult to identify because it can look like a seizure. But the key difference between the two is that you remain conscious during a cataplexy attack.
The muscle weakness tends to first affect the muscles in your face and neck and progress downward to your trunk and limbs. This can look like facial drooping and slurred speech (partial attacks) to collapse (complete attacks). Complete attacks are rare.
Most people can sense when an attack is coming on. The attacks typically go away completely within a few minutes without any lasting effects. People who experience cataplexy and know they’re having episodes have described them as “jelly attacks,” “zombie episodes” or “cabbaging.”
Cataplexy attacks look a little bit different in children. Children are more likely to have facial, jaw and eyelid weakness. It may look like they’re in pain or disgusted (grimacing). Or they may have other abnormal facial movements and expressions. Some children stick out their tongues during an attack.
People tend to mistake cataplexy in young children for clumsiness, seizures, fainting or attention-seeking behavior. If your child’s behavior changes, it’s important to check in with their healthcare provider.
Narcolepsy type 1 is the main cause of cataplexy. About 75% of people with narcolepsy experience cataplexy as a part of the condition.
More specifically, cataplexy happens due to a lack of a neurotransmitter called orexin, or hypocretin. This is a chemical that normally promotes wakefulness and leads to the suppression of rapid eye movement (REM) sleep.
During REM sleep, you experience muscle paralysis — this is normal and expected. If you lack orexin, experiencing intense emotion while you’re awake triggers certain areas of your brain. And without orexin, it leads to brief muscle paralysis — like you’d experience in REM sleep. This is cataplexy.
Strong emotions trigger cataplexy attacks. Negative emotions (like anger, fear or shock) are the most common triggers. Positive emotions (like laughter and excitement) can also trigger attacks.
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Medication is the main treatment for cataplexy. Wake-promoting therapy that helps treat narcolepsy often also helps cataplexy symptoms.
Medications that have U.S. Food and Drug (FDA) approval to treat cataplexy include:
Healthcare providers sometimes prescribe other medications for cataplexy. These are off-label, or non-FDA-approved, uses of the medications. They include:
Once you start treatment for cataplexy, it’s important to strictly follow your medication schedule. If you suddenly stop taking the medication, it can lead to severe cataplexy attacks.
You can’t always prevent cataplexy attacks. But many people with narcolepsy type 1 report that they’re more likely to experience attacks when they’re exhausted. Because of this, keeping a healthy sleep routine (sleep hygiene) may help to reduce the number of cataplexy attacks. Here are some tips:
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While cataplexy episodes can be scary, they’re not dangerous as long as you have a safe place to collapse. Most people who experience cataplexy know their triggers and avoid them. Here are some ways to take care of yourself if you experience cataplexy:
If you think you or your child are having cataplexy attacks, it’s important to see your healthcare provider. They can do an evaluation to see if you have narcolepsy and recommend a treatment plan.
Cataplexy involves sudden and brief muscle weakness that’s triggered by strong emotions, like laughter. While cataplexy isn’t usually dangerous directly, it can create risks in certain situations. It’s also a condition that can seriously disrupt your life. The good news is that cataplexy is treatable. Together, you and your healthcare provider can find a treatment plan that works best for you.
Last reviewed on 11/06/2023.
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Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy