Since excessive sleepiness was suggested by medical history, we performed an evaluation to make a definite diagnosis of narcolepsy with cataplexy. During the course of her evaluation, cataplexy was considered, as her bilateral atonic attacks seemed to occur when she was tense or startled, and she continued to maintain consciousness. Blood glucose, Holter electrocardiogram, interictal electroencephalogram, and brain magnetic resonance imaging results were normal. The patient underwent monitoring during these episodes. Basic lab values were within normal limits, including hemoglobin A1 C, which was stable at 6.8 %. Her body mass index was 32 (162 cm, 72 kg). Physical exam results, including vital signs, cardiopulmonary, and neurological findings, were normal. After 1 minute, she recovered and was able to stand and move normally. Although she was able to temporarily stand again and walk a few steps, she subsequently became unable to support herself and had to squat down. As can be seen in the video, when the patient was called into the clinic room, she first stood up from her chair and then assumed a half-sitting posture with her head and arms hanging down and her eyes closed. A video of an attack was recorded when she visited our clinic (see video link), which showed her experiencing paroxysmal weakness. The patient had experienced attacks at her physicians’ offices, and they had been witnessed by generalists, neurologists, and neurosurgeons, who had variously diagnosed essential tremor, orthostatic hypotension, epilepsy, and psychosomatic disease. Medications included metformin, voglibose, glimepiride, losartan, hydrochlorothiazide, nifedipine, and atorvastatin. The patient had a 4-year history of well-controlled diabetes, as well as hypertension and hyperlipidemia she had no complications from her diabetes. None of her relatives had similar symptoms. She occasionally experienced hypnagogic hallucinations, but did not experience sleep paralysis. The patient reported that she often fell asleep during the day, including during meals, and that she frequently took 15-minute naps that refreshed her temporarily. While she could not answer questions, she maintained consciousness and was able to hear the individuals around her and could accurately recall their conversations. During these episodes, she closed her eyes, squatted, and had difficulty speaking. telephone ringing, unexpectedly meeting an acquaintance, or being called into the clinic room by her doctor).
They occurred when she was tense or startled (e.g. A 72-year-old woman was referred to our hospital by her primary care doctor for a 15-year history of experiencing “attacks” during which she “lost body control.” These episodes occurred one to ten times on most days, and lasted approximately 1 minute.
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