1248 Redefining Cataplexy: A Patient-Derived Visual Severity Scale and Linguistic Audit

Abstract Introduction Cataplexy, a core symptom of Type 1 Narcolepsy, is defined as the intrusion of REM muscle atonia into wakefulness. However, current clinical verbiage lacks clarity, specifically the reliance on the term "muscle weakness." This ambiguity causes confusion, often conflating the specific neurological loss of muscle tone (ranging from mild laxity to complete paralysis) with the generalized fatigue or "sleep attacks" common in Hypersomnolence disorders. This resource proposes a shift in clinical discourse by introducing a visual and descriptive framework that more accurately captures the distinct phenomenology of cataplexy, separating the event from sleepiness. Methods Synthesizing the author’s lived experience with years of Narcolepsy community engagement, this project contrasts standard clinical definitions against shared patient realities. Digital art was utilized to translate the unseen depths of the lived experience into a comprehensive framework. This qualitative synthesis integrates the broad spectrum and severity ranges of the symptom to create a tangible reference for clinicians and patients. Results The resource focuses on two primary components to bridge the communication gap: The Visual Severity Scale: This spectrum differentiates episodes into "Minimal-Partial" (internal sensations, facial/neck droop, difficulties with speech), "Moderate-Partial" (leaning against a wall for support, loss of postural control), and "Severe-Complete" (overwhelming sensory experiences, melting or collapsing into a temporary paralysis). This visualization highlights the diverse variability and expansiveness of the symptom's presentation. Linguistic Audit: The resource argues that "weakness" is a reductive descriptor that semantically aligns with fatigue and minimizes the symptom's broad severity range. Clearer alternatives are proposed, such as “loss of muscle tone,” "muscular interference," "disruption," or "dissipation." These terms distinctively characterize the intrusion of atonia, distinguishing the mechanism from the heaviness of sleepiness. Conclusion By replacing ambiguous terminology and providing a visual spectrum of severity, this resource provides a necessary vocabulary for patients to articulate a difficult symptom more effectively and thoroughly. This framework improves the discussion between patient and provider, allowing clinicians to more accurately distinguish the neurological event of cataplexy from sleepiness, ultimately facilitating clearer diagnosis and management. Support (if any) None.