{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,6,13]],"date-time":"2025-06-13T11:24:49Z","timestamp":1749813889310},"reference-count":47,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2019,1,20]],"date-time":"2019-01-20T00:00:00Z","timestamp":1547942400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["81100990","81171252"],"award-info":[{"award-number":["81100990","81171252"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ann Clin Transl Neurol"],"published-print":{"date-parts":[[2019,2]]},"abstract":"Abstract<\/jats:title>Objective<\/jats:title>Cataplexy is a complicated and dynamic process in narcolepsy type 1 (NT<\/jats:styled-content>1) patients. This study aimed to clarify the distinct stages during a cataplectic attack and identify the changes of the primary motor cortex (PMC<\/jats:styled-content>) excitability during these stages.<\/jats:p><\/jats:sec>Methods<\/jats:title>Thirty\u2010five patients with NT<\/jats:styled-content>1 and 29 healthy controls were recruited to this study. Cataplectic stages were distinguished from a cataplectic attack by video\u2010polysomnogram monitoring. Transcranial magnetic stimulation motor\u2010evoked potential (TMS<\/jats:styled-content>\u2010MEP<\/jats:styled-content>) was performed to measure the excitability of PMC<\/jats:styled-content> during quiet wakefulness, laughter without cataplexy, and each cataplectic stage.<\/jats:p><\/jats:sec>Results<\/jats:title>Based on the video and electromyogram observations, a typical cataplectic attack (CA<\/jats:styled-content>) process is divided into four stages: triggering (CA<\/jats:styled-content>1), resisting (CA<\/jats:styled-content>2), atonic (CA<\/jats:styled-content>3), and recovering stages (CA<\/jats:styled-content>4). Compared with healthy controls, NT<\/jats:styled-content>1 patients showed significantly decreased intracortical facilitation during quiet wakefulness. During the laughter stage, both patients and controls showed increased MEP<\/jats:styled-content> amplitude compared with quiet wakefulness. The MEP<\/jats:styled-content> amplitude significantly increased even higher in CA<\/jats:styled-content>1 and 2, and then dramatically decreased in CA<\/jats:styled-content>3 accompanied with prolonged MEP<\/jats:styled-content> latency compared with the laughter stage and quiet wakefulness. The MEP<\/jats:styled-content> amplitude and latency gradually recovered during CA<\/jats:styled-content>4.<\/jats:p><\/jats:sec>Interpretation<\/jats:title>This study identifies four stages during cataplectic attack and reveals the existence of a resisting stage that might change the process of cataplexy. The fluctuation of MEP<\/jats:styled-content> amplitude and MEP<\/jats:styled-content> latency shows a potential participation of PMC<\/jats:styled-content> and motor control pathway during cataplexy, and the increased MEP<\/jats:styled-content> amplitude during CA<\/jats:styled-content>1 and 2 strongly implies a compensatory mechanism in motor control that may resist or avoid cataplectic attack.<\/jats:p><\/jats:sec>","DOI":"10.1002\/acn3.670","type":"journal-article","created":{"date-parts":[[2019,1,21]],"date-time":"2019-01-21T04:34:53Z","timestamp":1548045293000},"page":"210-221","update-policy":"http:\/\/dx.doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Fluctuation of primary motor cortex excitability during cataplexy in narcolepsy"],"prefix":"10.1002","volume":"6","author":[{"given":"Bei","family":"Huang","sequence":"first","affiliation":[{"name":"Department of Neurology Changzheng Hospital The Second Military Medical University 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