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Abstract Details

Orgasmolepsy-Presenting Symptom of Narcolepsy
P05 - (-)
BACKGROUND: Cataplexy, a hallmark symptom of narcolepsy, is typically triggered by strong emotional state. The usual triggers include laughter, crying and other high emotional state. Orgasmolepsy (cataplexy during orgasm and sexual intercourse) is a rare phenomenon, which has been described in patients with narcolepsy and daytime cataplexy. Poryazova et al, in a series of narcoleptic-cataplectic patients, orgasmolepsy was present in 3 out of 75 patients. We report a case of orgasmolepsy where it was not only the presenting symptom but also was not accompanied by any daytime cataplectic events.
DESIGN/METHODS: We report a 27 year old right handed Caucasian lady referred to the neurology clinic for evaluation of episodes of seizures. The episodes started about 4 years ago. During sex with her husband, she noticed that her heart would be pounding and suddenly she would be unable to move her whole body. She was unable to vocalize but was aware of her surroundings. The episodes would last for 3-4 minutes. She did complain of excessive daytime sleepiness occurring for the past year or so. She had difficulty initiating as well as maintaining sleep. She did give history suggestive of hypnagogic hallucinations. She was taking naps during the day and also dreaming during the naps.
RESULTS: Her neurological examination was unremarkable. Her Epworth sleepiness scale was 15/24. Her sleep efficiency was 91.7%, REM latency 154 minutes, RDI 2.7/hour and PLMS 0.6/hour. Her MSLT showed severely reduced sleep latency at 2.6 minutes. She had one sleep onset REM period. She was started on Modafinil and venlafaxine. Her episodes completely resolved after venlafaxine and sleepiness improved after modafinil.
CONCLUSIONS: Cataplexy after positive emotional triggers is the diagnostic feature of narcolepsy. Cataplexy during orgasm and sexual intercourse (orgasmolepsy) can be the presenting feature of narcolepsy.
Fouzia Siddiqui, MD, FAAN (Sentara Rockingham Memorial Hospital)
No disclosure on file
Eric Mittauer (Washington University, St. Louis School of Medicine) No disclosure on file