Baclofen can be an effective treatment for excessive daytime sleepiness and sleep fragmentation in patients with narcolepsy, according to research published in Pediatric Neurology.
The investigators studied the cases of 5 patients with narcolepsy associated with severe daytime sleepiness who had failed, had an inadequate response to, or had intolerable adverse effects associated with their first-line therapies. All patients who were evaluated had a positive response to treatment with baclofen, defined as improved sleep consolidation and reduction in excessive daytime sleepiness. Overall, 3 adolescent men (13, 16, and 17 y) and 2 adolescent women (14 and 15 y) were assessed.
With no current cure available for narcolepsy, first-line therapy for the disorder generally involves treatment with the wake-promoting agents modafinil or armodafinil. Traditional stimulants, including methylphenidate and amphetamines, are second- and third-line therapies. An alternative treatment for narcolepsy is sodium oxybate — a gamma-aminobutyric acid (GABA)-beta receptor agonist. Treatment goals of narcolepsy therapy are directed at specific relief of symptoms, including excessive daytime sleepiness, sleep fragmentation, and cataplexy.
Baclofen is a centrally acting GABA-beta agonist that is frequently used in pediatric patients for the treatment of dystonia, rigidity, and spasticity, which are associated with a variety of disorders, including cerebral palsy, multiple sclerosis, and poststroke symptomatology. Evidence suggests that baclofen may offer sleep benefits by reducing sleep latency and increasing slow-wave sleep.The use of baclofen has also been shown to increase total sleep time — both rapid eye movement (REM) and non-REM sleep duration — and has been associated with a significant reduction in the time spent awake after sleep onset.