BACKGROUND: Narcolepsy is a disabling sleep-wake disorder characterized by the 
pentad symptoms of excessive daytime sleepiness, sleep paralysis, sleep 
fragmentation, sleep-related hallucinations, and cataplexy. There is no curative 
therapy for narcolepsy. Treatment is therefore symptom directed. Symptom 
management is generally directed at improving excessive daytime sleepiness, 
sleep fragmentation, and cataplexy. First-line treatment for excessive daytime 
sleepiness is typically daily use of wake-promoting agents, such as modafinil or 
armodafinil, or stimulant therapy, such as methylphenidate or amphetamines. 
Alternatively, sodium oxybate can be used nightly for improved cataplexy, sleep 
consolidation, and following day wakefulness. These therapies can be limited in 
some patients because of inadequate efficacy, poor tolerability, or side 
effects.
METHODS: We describe five narcolepsy patients with severe excessive daytime 
sleepiness who had an inadequate response or experienced side effects with the 
initial therapies but had a positive response to treatment with baclofen.
RESULTS: These patients reported subjective improvement in sleep maintenance 
without fragmentation and daytime sleepiness. Average Epworth Sleepiness Scale 
assessment before treatment was 15.8 with post-treatment assessment being 10.4 
(P < 0.05).
CONCLUSIONS: Baclofen may be an effective treatment for excessive daytime 
sleepiness and sleep fragmentation in narcolepsy and warrants further study.