P-1347 - Reboxetine-treated narcolepsy: case report

Abstract

Narcolepsy is a disabling sleep disorder affecting 0.02% of adults worldwide. It is characterized by irresistible daytime sleepiness, catalepsy and can be associated with sleep paralysis, and hipnagogic hallucinations. The treatment is essentially symptomatic with stimulant drugs (mostly dopaminergic) for daytime sleepiness and sleep attacks, antidepressants (mostly noradrenergic) for catalepsy and hypnotics for disturbed night-time sleep. Special care must be taken, with close blood monitoring for toxicity, in the prescription of these drugs to patients with concurrent renal or hepatic disease. The authors present a case of a 72 year-old female patient with the diagnoses of narcolepsy and conjoint severe chronic renal and hepatic insufficiency, with intolerance for most of the recommended treatments for her sleep disorder. The patient is observed in a psychiatric consultation after several bone fractures due to cataleptic phenomena. We describe a successful therapeutical approach with reboxetine, with a significant improvement in daytime sleepiness, reflected by a decrease of 52% on the Epworth Sleepiness Scale. Furthermore, a significant reduction in the cataplexy subscore of the Ullanlinna Narcolepsy Scale was also found. Consequently, this treatment led to a decrease in the frequency of catalepsy attacks and secondary traumatic injuries and an increase in the Global Assessment of Functioning scale.