What question did this study set out to answer?

This report aims to demonstrate the potential for high-dose baclofen to induce narcolepsy-like symptoms and cataplexy.

April 22, 2026Open Access

Baclofen-Associated Narcolepsy-Like Presentation with Cataplexy: A Case Report

LRLouis RaletCentre Hospitalier Universitaire Brugmann JNJohan NewellCentre Hospitalier Interrégional Edith Cavell DNDaniel NeuUniversité Libre de Bruxelles

Key Points

This report aims to demonstrate the potential for high-dose baclofen to induce narcolepsy-like symptoms and cataplexy.
Reported symptoms after increasing baclofen to 200 mg/day in a male with alcohol use disorder.
Conducted polysomnography (PSG), multiple sleep latency test (MSLT), and HLA typing.
Symptoms resolved following dose reduction to 87.5–100 mg/day.
Patient exhibited excessive daytime sleepiness (ESS score 17/24) and cataplexy-like episodes.
HLA typing ruled out primary narcolepsy.
Symptoms improved significantly after baclofen dose was reduced (ESS score 3/24).

Abstract

• High-dose baclofen (200 mg/day) triggered reversible narcolepsy-like symptoms. • Emotion-triggered cataplexy-like episodes and brief sleep attacks occurred. • Symptoms remitted after dose reduction to 87.5–100 mg/day (positive dechallenge). • PSG/MSLT and HLA typing argued against primary narcolepsy. • GABA-B–mediated inhibition of orexin neurons is a plausible mechanism. Baclofen, a gamma-aminobutyric acid type B (GABA-B) receptor agonist, is used for spasticity and off-label for alcohol use disorder (AUD). Narcolepsy is a sleep–wake disorder defined by excessive daytime sleepiness (EDS), rapid eye movement sleep dissociation, and, in type 1 narcolepsy, cataplexy. We report a suspected baclofen-induced narcolepsy-like condition, involving cataplexy-like episodes and sleep attacks that resolved upon dose reduction. A 40-year-old male with AUD increased baclofen to 200 mg/day. He developed severe EDS (Epworth Sleepiness Scale (ESS) 17/24), with emotion-triggered, brief episodes of transient muscle atonia and irresistible sleep attacks. These paroxysmal symptoms were distinct from baseline sedation. Human leukocyte antigen (HLA) typing, blood tests, polysomnography (PSG), and a multiple sleep latency test (MSLT) were performed after the acute phase. Symptoms resolved after reducing baclofen to alternating 87.5 and 100 mg/day (ESS 3/24). HLA was negative for any alleles associated with narcolepsy. PSG and MSLT excluded primary narcolepsy. High-dose baclofen may induce a reversible narcolepsy-like presentation with excessive daytime sleepiness, sleep attacks and cataplexy. The temporal association with dose escalation, worsening at higher doses, and complete resolution after dose reduction support baclofen involvement. This observation contrasts with prior reports suggesting a beneficial effect of baclofen on cataplexy and may reflect GABA-B–mediated inhibition of orexinergic neurons. Clinicians should consider this potential adverse effect when prescribing high doses of baclofen, including off-label for alcohol use disorder.

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