Abstract
Seven patients with narcolepsy and cataplexy were treated with clomipramine. This abolished cataplexy in three patients and resulted in a reduction in the frequency of attacks in the others. Tolerance to clomipramine did not develop and treatment remained effective over a one-year period. One patient had a considerable increase in weight but no other side-effects of clomipramine occurred. Clomipramine had no action on narcolepsy but given together with amphetamines resulted in a reduction in the amphetamine dosage required to control narcolepsy. The life-long nature, familial occurrence and absence of specific pathology in the narcoleptic syndrome is consistent with an inborn error of metabolism. The concentration of homovanillic acid in the CSF of six patients with narcolepsy was approximately half normal. One of these patients had not been treated with amphetamines. This finding could be explained by a reduced cerebral metabolism of catecholamines in the narcoleptic syndrome.
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