LAUSR

DISCUSSION Guanfacine may suppress rapid eye movement sleep, modulate sleep architecture, and can result in less sleepwalking. As a selective α-adrenergic 2A agonist, it has the ability to regulate glutamatergic and catecholamine systems, both implicated in the neurochemistry of sleepwalking. Benzodiazepines lessen sleepwalking through a sedativehypnotic effect. Antidepressant medications are thought to decrease sleepwalking owing to anxiolytic properties. It is hypothesized that guanfacine might facilitate control of sleepwalking via a similar mechanism. Guanfacine, within days, quickly diminished sleepwalking in this vignette, but it reemerged with noncompliance. Improvement was sustained for more than 15 months. Given the case chronicity and apparent improvement, guanfacine seemed to offer some efficacy; however, age-related improvement is also possible. For children with sleepwalking and ADHD, guanfacine might reduce symptoms of ADHD without worsening sleepwalking, which reportedly exacerbated by stimulant medicines. Desirable effects included quick onset of action, less sleep walking, and absence of medicinal tolerance. Guanfacine might be a useful medicine to consider prescribing for appropriately selected pediatric patients. Written informed consent was obtained from the patient about publication of this report. A copy is available on request.