Unusually prolonged rebound cataplexy after withdrawal of fluoxetine

We report an unusually prolonged cataplectic attack in a patient with narcolepsy who stopped fluoxetine to perform sleep investigations. A 57-year-old woman with a 24-year history of clinically definite narcolepsy with cataplexy was referred for reassessment of treatment because of increasing insomnia. The patient reported excessive daytime sleepiness (Epworth Sleepiness Scale score 20/24) and maintenance insomnia with creeping and itching sensations in the legs accompanied by an urge to move. She had daily episodes of cataplexy with sagging of the face, jaw, and eyelids, slurred speech, and rarely head drooping. The episodes were triggered by positive or negative emotions and lasted a few seconds up to 1 minute. She had also monthly episodes of sleep paralysis and auditory hypnagogic hallucinations. The Ullanlinna Narcolepsy Scale score was 30 of 44 (a score of >14 suggests narcolepsy), and the Swiss Narcolepsy Scale score was −66 (a score of <0 suggests narcolepsy). …