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Cataplexy, a sudden loss of muscle tone triggered by emotions, is one of the main clinical features of narcolepsy. Recent studies have demonstrated that a dramatic reduction in hypothalamic orexin/hypocretin neurons plays a role in the pathogenesis of narcolepsy.1,2⇓ These neurons contain dynorphin, an endogenous opiate.3 Therefore, the involvement of opioidergic mechanisms in the pathogenesis of narcolepsy merits further consideration.
We studied two patients with narcolepsy in whom a recurrence of cataplectic attacks during withdrawal from tranylcypromine, an irreversible monoamine oxidase inhibitor, was successfully treated with tramadol, a centrally acting opioid analgesic.
Case reports.
Case 1.
A 69-year-old woman was admitted to our clinic because cataplexy was poorly controlled by tranylcypromine at a dosage of 50 mg/day. Cataplexies occurred one to five times per day, lasted up to several minutes, and were triggered by even minor emotions. The patient was HLA-DR2 positive, and an earlier Multiple Sleep Latency Test (MSLT) had documented a shortened …
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