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This chapter reviews the neuroimaging findings devoted to the effects of treatment in narcolepsy. These studies involved functional neuroimaging methods such as single photon emission computed tomography (SPECT), positron emission tomography (PET), and functional magnetic resonance imaging (fMRI). The majority of them focused on modafinil, with also early reports on amphetamines and methylphenidate. In narcoleptic patients single-dose treatment effects were also studied with fMRI. PET and SPECT were used to investigate brain activity changes induced by a prolonged administration of modafinil in narcoleptic patients. An 18F-fluorodeoxyglucose (18F-FDG) PET study evaluated brain glucose metabolism (CMRglu) during baseline wakefulness in eight patients and eight controls before and after two weeks of treatment with modafinil. Decreased CMRglu was observed in the brainstem, hypothalamus, thalamus, and mesiotemporal areas in narcoleptics compared to controls, both before and after treatment.
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