But Pavlov's research has been thwarted by his dogs falling asleep during training or on repetition of the conditioned reflex, although they became alert in response to something new-the orientation reflex. Here is an exposition of reflexes that are innate to any nervous system, and those that are learned by association between a neutral stimulus and a primitive response conditioned reflexes fade if not actively habituated and through internal inhibition when the conditioning stimulus is no longer followed by the expected ‘reward’. He has been reading Ivan Pavlov, but not yet ‘Conditioned reflexes: an investigation of the physiological activity of the cerebral cortex’ based on lectures given in 1924 to the Military Medical Academy in Petrograd (1926), and translated into English by GV Anrep (1927). Apart from non-convulsive epilepsy, the differential diagnosis might include pyknolepsy (originally described, unhelpfully, as ‘short narcoleptic attacks’ by Friedmann, 1906), hysteria, ‘Lachschlag’ (Oppenheim, 1902: in which the patient is deeply unconscious during the emotion-induced episode and without sleep attacks), Pickwickian ‘Fat Boy’ disorder, encephalitis lethargica and cerebral tumour but the absence of co-existent symptoms and the benign natural history of narcolepsy usually serve to distinguish these conditions.īeyond his clinical interest, Dr Adie wants to understand the nature of sleep. It follows that sleep attacks and cataplexy have the same mechanism. In short, ‘two kinds of sudden attack occur, sleep … with cause and cataplexy on emotion … anyone possessing this knowledge would be able to recognize a typical case’, although transitional states do exist. Rejecting all foreign suggestions (‘chute ou astasie’, ‘kataleptische Starre’, ‘kataleptische Hemmung’, ‘plötzlicher Tonusverlust’ or ‘affektiver Tonusverlust’ and ‘Tonusblockade’ ) and noting that translating Lowenfeld's term as catalepsy will not work (already having meaning in Anglophone medicine), Dr Adie suggests the term cataplexy for the falling attacks.
The terms ‘hypnolepsy’ and ‘Einschlafsucht’ have been proposed but Dr Adie favours ‘narcolepsy’ for the sleep attacks. Gélineau's patient fell down at the prospect of a good business deal or finding that he had been dealt a winning hand at cards Redlich's patient weakened and became flaccid during coitus. As the head lolls, the patient may jerk upright a few times so that the unwary diagnose epilepsy or chorea. Falling attacks precipitated by emotion, usually laughter but also anger and annoyance and often associated with grimacing, protrusion of the tongue and stammering, usually start later. What can be said of this mysterious disorder usually affecting otherwise healthy males in their teens or as young adults who cannot resist the urge to nod off for a few seconds or longer, sometimes in circumstances conducive to sleep but typically also at inappropriate times? Two soldiers describe sleeping whilst on listening-post duty-an offence carrying the death-penalty-and others have been saved by medical intervention prior to courts-martial. Leslie W, aged 16, sleeps whilst talking to the Matron of the National Hospital. Captain X, aged 35, sleeps through one of Dr Adie's lectures, as host at his Corps’ Mess dinner, and whilst driving his car unaffected either by danger or excitement during the Great War, with laughter he goes ‘floppy all over’. On learning that a boy cycling from London to visit her home has been killed, Mrs C, aged 42, fell and lay powerless on a couch now any unpleasant emotion provokes these episodes and she has a morbid fear of being thought dead if found in an attack ‘London consultants’ have diagnosed hysteria and epilepsy without convulsions. Freda W, aged 19, under the care of Dr James Taylor, has fallen from her bicycle and slept in the middle of the road’ … and with laughter … ‘the limbs crumple up’. Mis-diagnosed with petit mal epilepsy at Queen Square, Olive P, aged 14, complains that ‘when I laugh I cannot stand’ … and she ‘sleeps at inconvenient times’ by chance, Dr Adie comes across Gélineau's description when looking up his preferred diagnosis of ‘Lachschlag’.