Introduction to Video-Clinical Corners in Sleep Medicine This section is a new feature of Sleep Medicine allowing readers to submit unique sleep related cases with video segments as a way to enhance educational value in a manner unattainable through paper format. Please see our web site’s (http://ees.elsevier.com/ sleep/) Guide for Authors for instructions. We hope this section will be enriched by the contributions of our colleagues who wish to offer stimulating opportunities for discussion and new insights into the field of sleep. doi:10.1016/S1389-9457(10)00192-9 Pseudocataplexy in narcolepsy with cataplexy Giuseppe Plazzi a, * , Ramin Khatami b , Leonardo Serra a , Fabio Pizza a , Claudio L. Bassetti b,c, ** a Department of Neurological Sciences, University of Bologna, Bologna, Italy b Department of Neurology, University Hospital of Zurich, Zurich, Switzerland c Department of Neurology, Neurocenter (EOC) of Southern Switzerland, Lugano, Switzerland article info Article history: Available online 14 May 2010 Keywords: Narcolepsy Cataplexy Pseudoseizure Video-polygraphy Differential diagnosis Pseudocataplexy 1. Introduction Cataplexy is a transient loss of muscle tone triggered by emo- tions pathognomonic for narcolepsy with cataplexy. Cataplexy is a partial phenomenon such as ‘‘cataplectic facies” [1], or knees buckling, occasionally involving the whole body (falls) [2,3]. Cata- plexy diagnosis relies on clinical grounds and history and is rarely confirmed by video-polygraphy [1,4]. Differential diagnosis includes different conditions such as ato- nic seizures, startle-syndromes, drop attacks associated with verte- brobasilar ischemia, and psychogenic spells (pseudocataplexy) [3]. Pseudocataplexy has scarcely been reported, possibly because of its association with malingering or paranoid schizophrenia [5]. We present two narcolepsy with cataplexy patients with coex- istent pseudocataplexy documented for the first time by video- polygraphy. 2. Case description 2.1. Patient 1 A 9-year-old girl presented with excessive daytime sleepiness (EDS), irritability, hallucinations, and sudden episodes of transient facial or generalized weakness provoked by laughing and tickling, leading to falls. EDS rapidly increased forcing school withdrawal. A somatoform disorder was diagnosed. Seven months after EDS onset, her mother described two types of spells: ‘‘true falls,” present since EDS onset and elicited by jok- ing/tickling, appeared predominantly at home in the evening; and ‘‘false falls” that appeared since physicians considered her symptoms ‘‘unreal.” During the ‘‘false falls” the girl ‘‘did not display a drunken expression and cried.” Clinical, neuropsychological eval- uations (intelligence quotient Wechsler Intelligence Scale-Revised total score 114), and brain Magnetic Resonance Imaging were nor- mal. Narcolepsy with cataplexy diagnosis was instrumentally con- firmed (Table 1). Cataplectic attack (Video, segment 1, Fig. 1a). While joking and being tickled by her mother, she stopped laughing, presented a droopy expression, a sudden knee bending, loss of arms and trunk strength, and fell a second later. After few seconds of immobility, she gradually regained muscle tone, obeying orders, sitting up and finally speaking. The episode lasted 37 s. Polygraphy initially (3 s) showed intermittent suppression of EMG chin muscle tone followed by persistent atonia (9 s). Pseudocataplectic attacks (Video, segment 2, Fig. 1b). While talk- ing to her mother she gradually and intermittently buckled her knees, falling forward and landing, supported by her hands and forehead. She did not speak, but after 16 s she cried and was * Correspondence to: G. Plazzi, Sleep Disorders Center, Department of Neurolog- ical Sciences. University of Bologna, Via Ugo Foscolo, 7 - 40123 Bologna, Italy. Tel.: +39 051 2092926; fax: +39 051 2092963. ** Corresponding author at: Department of Neurology, UniversistätsSpital Zürich, Frauenklinikstrasse 26, 8091 Zürich, Switzerland. Tel.: +41 044 2555503; fax: +41 044 2554649, Neurology Department, Ospedale Civico, Via Tesserete 46, 6903 Lugano, Switzerland. Tel.: +41 91 811 6658; fax: +41 91 811 6915. E-mail addresses: giuseppe.plazzi@unibo.it (G. Plazzi), claudio.bassetti@usz.ch, claudio.bassetti@eoc.ch (C.L. Bassetti). Sleep Medicine 11 (2010) 591–594 Contents lists available at ScienceDirect Sleep Medicine journal homepage: www.elsevier.com/locate/sleep