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Narcolepsy – Anti-Cataplectic Therapy — SCE Neurology MCQ

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ModerateSleep DisordersNarcolepsy – Anti-Cataplectic TherapySCE Neurology

A 30-year-old woman with narcolepsy type 1 has excessive daytime sleepiness and severe cataplexy (multiple daily episodes triggered by laughter and surprise). Modafinil controls her sleepiness but not her cataplexy. What additional medication specifically targets cataplexy?

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Correct answer: B — Sodium oxybate (taken at night) — or a low-dose antidepressant (venlafaxine, clomipramine) as alternative anti-cataplectic agents

Cataplexy-specific treatments include: (1) sodium oxybate (Xyrem — gamma-hydroxybutyrate, taken in two doses at night) — treats both cataplexy and daytime sleepiness, (2) pitolisant (H3 receptor antagonist — also treats both), (3) antidepressants (venlafaxine, clomipramine, fluoxetine) — suppress REM sleep and reduce cataplexy. Modafinil treats daytime sleepiness but has no anti-cataplectic effect. A: Caffeine does not treat cataplexy. C: Levodopa is for PD. D: Methylphenidate treats sleepiness but not cataplexy. E: Melatonin is for circadian disorders/RBD.

Reference: EAN Narcolepsy Guidelines (2019); NICE; BNF