In Reply.—
The issues raised by Dr Clark illustrate the complexities involved in diagnosing and treating patients with narcolepsy. Since our initial report in the Archives,1 we have reported on four additional patients in whom long-standing narcolepsy has been successfully treated with propranolol for short-term periods.2 None of these patients appeared to fit the description of the patients whom Dr Clark reported to be "hyperactive, agitated or burnt out." In addition, the histories of our patients were typical of narcolepsy in terms of the development and progression of their disorders as well as their initial symptoms.In the patient described in our case report, the paranoid qualities noted were thought to be related to the high level (360 mg) of daily intake of methylphenidate. As we reported, there was a distinct improvement in this behavior once the withdrawal of methylphenidate consumption was completed.1The finding that propranolol therapy may