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A defining and enigmatic aspect is that certain emotional stimuli usually trigger the episodes. Cataplexy can be the most disabling symptom of the narcolepsy syndrome, severely limiting normal activities of daily living. Antidepressant drug therapy at relatively low doses is the traditional treatment; these most likely work through inhibiting REM sleep, predominantly by increasing brain monoamine concentrations. Sodium oxybate is probably the most effective drug for severe cataplexy, taken before overnight sleep and once through the night; its precise mechanism of action remains obscure. Pitolisant is a new agent for treating the excessive daytime sleepiness of narcolepsy that also helps cataplexy control by increasing histamine concentrations in the hypothalamus. Further understanding of the neurobiology of cataplexy and how it relates to hypocretin deficiency should improve our understanding of the brain\u2019s emotional processing and provide insights into REM sleep and its control.<\/jats:p>","DOI":"10.1136\/practneurol-2018-002001","type":"journal-article","created":{"date-parts":[[2018,10,24]],"date-time":"2018-10-24T12:18:24Z","timestamp":1540383504000},"page":"21-27","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":26,"title":["Cataplexy"],"prefix":"10.1136","volume":"19","author":[{"given":"Paul","family":"Reading","sequence":"first","affiliation":[{"name":"Department of Neurology, The James Cook University Hospital, Middlesbrough TS4 3BW, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2018,10,24]]},"reference":[{"key":"2025090410464848000_19.1.21.1","unstructured":"American Academy of Sleep Medicine . 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