[The Kleine-Levin syndrome and the treatment with methylphenidate].
Brouns S H A,Schieveld J,Leue C
Tijdschrift voor psychiatrie
A 17-year-old man was referred to the Med-Psych-Unit because of recurrent episodes of hypersomnia, megaphagia, hypersexual behaviour and cognitive disturbances. Over the period of three years he suffered more than 10 episodes of hypersomnia each lasting 8 to 16 days. The clinical presentation was suggestive of the Kleine-Levin syndrome. The symptoms disappeared after treatment with methylphenidate, but it was not clear whether this could be attributed to the medication or to the self-limiting character of the illness. The Kleine-Levin syndrome is often clinically not recognised due to the variation in the symptoms and the lack of objective diagnostic examination.
KLEINE - LEVIN SYNDROME (A Case Report).
Raju Msvk
Medical journal, Armed Forces India
A 30 year old male soldier suffered from five episodes of hypersomnia. Each episode was associated with megaphagia, mental confusion, irritability, coenesthopathic hallucinations and sexual disinhibition. The average duration of each episode was ten weeks with symptomfree intervals ranging from two weeks to one year. The patient responded well to treatment with carbamazepine and fenfluramine.
10.1016/S0377-1237(17)31071-7
Apparent resolution of hypersomnia episodes in two patients with Kleine-Levin syndrome following treatment with the melatonin receptor agonist ramelteon.
Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine
Kleine-Levin syndrome (KLS) is a rare disorder characterized by episodic bouts of severe hypersomnia associated with cognitive and behavioral abnormalities and normal alertness and functioning in between episodes. The pathophysiology is unclear but may involve neurotransmitter abnormalities, hypothalamic/thalamic dysfunction, viral/autoimmune etiology, or circadian abnormalities. No single treatment has been shown to be reliably efficacious; lithium has demonstrated the most consistent efficacy, although many do not respond and its use is limited by side effects. Due to the evidence of circadian involvement, we hypothesized that strengthening circadian signals may ameliorate symptoms. Ramelteon is a potent melatonin receptor agonist. In this report, two patients with KLS are described with apparent resolution of hypersomnia episodes following ramelteon initiation. CITATION:Dominguez D, Rudock R, Tomko S, Pathak S, Mignot E, Licis A. Apparent resolution of hypersomnia episodes in two patients with Kleine-Levin syndrome following treatment with the melatonin receptor agonist ramelteon. . 2024;20(4):657-662.
10.5664/jcsm.10968
Kleine-levin syndrome treated with clarithromycin.
Rezvanian Elham,Watson Nathaniel F
Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine
Kleine-Levin syndrome (KLS) is a rare sleep disorder characterized by periodic hypersomnia and various degrees of cognitive and behavioral disturbance, hyperphagia, and hypersexuality. Effective treatment is challenging. Stimulants marginally address sleepiness, but may increase irritability and do not improve cognitive and behavioral disturbances. Modafinil may shorten the symptomatic period but not the recurrence rate. Lithium and carbamazepine are beneficial in some cases, possibly related to similarities between KLS and affective disorders. Currently, no single medication is consistently successful in treating the syndrome. Here we report the short-term effect of clarithromycin in a patient with KLS.
10.5664/jcsm.3176
A case of Kleine-Levin syndrome arising during chemotherapy: efficacy of oral L-carnitine.
Sleep and biological rhythms
A woman in her 50 s with Kleine-Levin syndrome (KLS) was referred to our sleep clinic for recurrent episodes of sleep hypersomnia lasting for two to 3 days, despite attempts to remain awake. These episodes were unaccompanied by anxiety or depression, increased appetite, increased sex drive, irritability, or hallucinations, and had first appeared during chemotherapy for malignant lymphoma. Video polysomnography revealed mild obstructive sleep apnea syndrome (apnea-hypopnea index 7.9/h), but no other abnormalities. All blood tests and brain imaging investigations, including brain MRI and A I-ioflupane SPECT, yielded normal results. Oral L-carnitine was found to be effective for shortening the period of hypersomnolence, reducing the degree of hypersomnolence, and prolonging the inter-episode period. Since it has been reported that alkylating agents may induce carnitine deficiency, the present observations appear to support the involvement of carnitine in the onset of KLS.
10.1007/s41105-022-00434-0
A case of Kleine-Levin syndrome successfully treated with Escitalopram.
SAGE open medical case reports
Kleine-Levin syndrome (KLS) is an extremely rare relapsing-remitting neuropsychiatric condition characterized by recurrent incidents of major hypersomnolence along with hyperphagia, hypersexual behavior, and mood or cognitive disturbances alternating with asymptomatic periods. Here, we present a case of a young male chiefly presenting with recurring episodes of acute onset behavioral changes. The patient's episodes were characterized by repetitive incidents of prolonged sleep for more than 20 h, followed by social withdrawal and apathy. He was diagnosed with KLS because of the periodic patterns of hypersomnolence accompanied by other cognitive and mood disturbances and lacked characteristics of central hypersomnolence disorders or atypical depression. There are varying success rates among medications such as lithium, stimulants such as modafinil, antiepileptics such as carbamazepine and valproate. Similarly, the use of antidepressants such as tricyclic agents and selective serotonin reuptake inhibitors has largely been negative. Our case report addresses a patient with KLS who was successfully treated with 20 mg of Escitalopram.
10.1177/2050313X221110985
Sleep Disorders in Childhood.
Continuum (Minneapolis, Minn.)
OBJECTIVE:This article provides a comprehensive review of pediatric sleep disorders including the clinical features, diagnosis, and treatment of sleep-disordered breathing, insomnia, parasomnias, restless sleep disorder, restless legs syndrome, narcolepsy in childhood, and Kleine-Levin syndrome. LATEST DEVELOPMENTS:Our understanding of pediatric sleep pathophysiology continues to evolve, and diagnostic and treatment modalities have expanded. A low-sodium oxybate formulation was approved in July 2020 in the United States to treat cataplexy and excessive daytime sleepiness in patients 7 years old and older with narcolepsy. A validated pediatric hypersomnolence survey for pediatric narcolepsy and idiopathic hypersomnia with high sensitivity, specificity, and interrater reliability is now available. ESSENTIAL POINTS:The clinical presentation, diagnostics, and treatment of children with sleep disorders differ from those of adults. Untreated sleep disorders in childhood can lead to adverse physical and psychological consequences in adults. Correctly diagnosing and treating sleep disorders in youth can prevent a significant burden of disease in adulthood.
10.1212/CON.0000000000001285