Baclofen for narcolepsy with cataplexy: two cases

Abstract

Elliott Kyung Lee,1,2 Alan Bruce Douglass1,2 1Department of Psychiatry, Faculty of Medicine, Institute of Mental Health Research, University of Ottawa, 2Royal Ottawa Mental Health Center, Ottawa, ON, Canada Abstract: Narcolepsy is a disabling sleep disorder characterized by daytime hypersomnolence. Those with cataplexy have spells of muscle weakness precipitated by strong emotions, especially laughter or surprise. Cataplexy treatments include antidepressants or a GABA-B agonist, gamma hydroxybutyrate (GHB). GHB is the most effective treatment for cataplexy, but is expensive and can have significant side effects. A recent report of a murine model of narcolepsy-cataplexy suggests R-baclofen has potential efficacy against cataplexy. We report on two narcolepsy patients with multiple daily cataplexy episodes, one of whom had been effectively treated with GHB, but had to discontinue it for unrelated medical reasons. Both subsequently tried baclofen and experienced almost complete resolution of cataplexy. This report suggests baclofen can be an effective treatment for cataplexy in humans and warrants further study. Keywords: hypersomnolence, gamma hydroxybutyrate, excessive daytime sleepiness