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Furihata R, Endo D, Nagaoka K, Hori A, Ito T, Chin K, Akahoshi T. A case of Kleine-Levin syndrome arising during chemotherapy: efficacy of oral L-carnitine. Sleep Biol Rhythms 2023; 21:257-260. [PMID: 38469287 PMCID: PMC10899917 DOI: 10.1007/s41105-022-00434-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 11/16/2022] [Indexed: 11/28/2022]
Abstract
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 123I-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.
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Affiliation(s)
- Ryuji Furihata
- Agency for Student Support and Disability Resources, Kyoto University, Kyoto, Japan
| | - Daisuke Endo
- Shinjuku Sleep and Respiratory Clinic, KEISHINKINENKAI Medical Corporation, Shinjuku-I-Land Tower 12F, 6-5-1 Nishishinjuku, Shinjuku-Ku, Tokyo, 163-1312 Japan
| | - Kenichi Nagaoka
- Shinjuku Sleep and Respiratory Clinic, KEISHINKINENKAI Medical Corporation, Shinjuku-I-Land Tower 12F, 6-5-1 Nishishinjuku, Shinjuku-Ku, Tokyo, 163-1312 Japan
- Division of Respiratory Medicine, Department of Internal Medicine, Nihon University, Tokyo, Japan
| | - Ayako Hori
- Shinjuku Sleep and Respiratory Clinic, KEISHINKINENKAI Medical Corporation, Shinjuku-I-Land Tower 12F, 6-5-1 Nishishinjuku, Shinjuku-Ku, Tokyo, 163-1312 Japan
| | - Tatsuya Ito
- Shinjuku Sleep and Respiratory Clinic, KEISHINKINENKAI Medical Corporation, Shinjuku-I-Land Tower 12F, 6-5-1 Nishishinjuku, Shinjuku-Ku, Tokyo, 163-1312 Japan
| | - Kazuo Chin
- Division of Sleep Medicine, Department of Sleep Medicine and Respiratory Care, Nihon University, Tokyo, Japan
- Department of Human Disease Genomics, Center for Genomic Medicine, Graduate School Medicine, Kyoto University, Kyoto, Japan
| | - Toshiki Akahoshi
- Shinjuku Sleep and Respiratory Clinic, KEISHINKINENKAI Medical Corporation, Shinjuku-I-Land Tower 12F, 6-5-1 Nishishinjuku, Shinjuku-Ku, Tokyo, 163-1312 Japan
- Division of Respiratory Medicine, Department of Internal Medicine, Nihon University, Tokyo, Japan
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Alemohammad ZB, Jamshidi S, Najafi A. Periodic hypersomnolence in a young female patient: a case report and literature review. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2022. [DOI: 10.1186/s41983-022-00466-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Kleine–Levin syndrome (KLS) is a disease with periodic hypersomnolence accompanied by abnormal behavior with a rare prevalence in female.
Case presentation
Here, we report a young lady with chief complaint of hypersomnolence for 6 years of visits and any history of sleep attack, sleep paralysis, and cataplexy. Polysomnography was performed for the patient. The respiratory disturbance index was normal. In MSLT the patient had two SOREMs with mean sleep latency of 7 min. She was diagnosed as Kleine–Levin syndrome as the sleepiness symptoms had a periodic pattern without other characteristics of central hypersomnolence disorders. The patient did not report behavioral characteristics of KLS reported in previous literature. She improved spontaneously after a while in follow-ups without any further treatment.
Conclusions
Although KLS is reported rarely in female gender and there are previous defined behavioral symptoms for this syndrome, periodic pattern of sleepiness should raise this diagnosis after exclusion of other hypersomnolence causes.
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Abstract
Kleine-Levin syndrome (KLS) is a rare disorder characterized by discrete episodes of hypersomnia associated with cognitive and behavioural abnormalities, as well as normal alertness and function between episodes. The prevalence of KLS may be underestimated as it is often misdiagnosed and managed as another sleep disorder, neurological disorder or psychiatric condition. KLS is more typically seen in adolescence than at other ages, and is more common in males than in females. There are currently neither standard biomarkers nor specific imaging study findings, making the diagnosis of KLS a challenge. Furthermore, there are no consistently effective therapies. The prognosis, however, is felt to be overall favorable, as episodes become progressively milder and less frequent before resolving entirely in most patients.
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Affiliation(s)
- Olufunke Afolabi-Brown
- Sleep Center, The Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104.
| | - Thornton B A Mason
- Sleep Center, The Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104.
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Arnulf I, Rico TJ, Mignot E. Diagnosis, disease course, and management of patients with Kleine-Levin syndrome. Lancet Neurol 2012; 11:918-28. [PMID: 22995695 DOI: 10.1016/s1474-4422(12)70187-4] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Arnulf I, Lecendreux M, Franco P, Dauvilliers Y. Le syndrome de Kleine-Levin. Rev Neurol (Paris) 2008; 164:658-68. [DOI: 10.1016/j.neurol.2008.04.020] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2007] [Revised: 04/15/2008] [Accepted: 04/19/2008] [Indexed: 11/15/2022]
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Arnulf I, Zeitzer JM, File J, Farber N, Mignot E. Kleine-Levin syndrome: a systematic review of 186 cases in the literature. ACTA ACUST UNITED AC 2005; 128:2763-76. [PMID: 16230322 DOI: 10.1093/brain/awh620] [Citation(s) in RCA: 164] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Kleine-Levin syndrome (KLS) is a rare disorder with symptoms that include periodic hypersomnia, cognitive and behavioural disturbances. Large series of patients are lacking. In order to report on various KLS symptoms, identify risk factors and analyse treatment response, we performed a systematic review of 195 articles, written in English and non-English languages, which are available on Medline dating from 1962 to 2004. Doubtful or duplicate cases, case series without individual details and reviews (n = 56 articles) were excluded. In addition, the details of 186 patients from 139 articles were compiled. Primary KLS cases (n = 168) were found mostly in men (68%) and occurred sporadically worldwide. The median age of onset was 15 years (range 4-82 years, 81% during the second decade) and the syndrome lasted 8 years, with seven episodes of 10 days, recurring every 3.5 months (median values) with the disease lasting longer in women and in patients with less frequent episodes during the first year. It was precipitated most frequently by infections (38.2%), head trauma (9%), or alcohol consumption (5.4%). Common symptoms were hypersomnia (100%), cognitive changes (96%, including a specific feeling of derealization), eating disturbances (80%), hypersexuality (43%), compulsions (29%), and depressed mood (48%). In 75 treated patients (213 trials), somnolence decreased using stimulants (mainly amphetamines) in 40% of cases, while neuroleptics and antidepressants were of poor benefit. Only lithium (but not carbamazepine or other antiepileptics) had a higher reported response rate (41%) for stopping relapses when compared to medical abstention (19%). Secondary KLS (n = 18) patients were older and had more frequent and longer episodes, but had clinical symptoms and treatment responses similar to primary cases. In conclusion, KLS is a unique disease which may be more severe in female and secondary cases.
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Affiliation(s)
- I Arnulf
- Stanford University Center for Narcolepsy, Palo Alto, CA, USA.
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Abstract
Kleine-Levin syndrome is a rare self-limited disorder which usually affects adolescent males and is characterized by episodic hypersomnia, increased appetite, and behavioral/psychiatric disturbances. Individuals are normal between the attacks. The case of an adolescent boy is presented who suffered from recurrent sleepiness, hyperphagia, and behavioral disturbances such as rocking, punching and pacing, and was originally misdiagnosed as suffering from encephalitis. Before the diagnosis of Kleine-Levin was given, the patient underwent unnecessary investigations and treatment which, in turn, complicated his clinical condition both physically as well as psychologically. In the course of five years he had four such episodes which appeared to have progressively milder manifestations. Between episodes he was normal. It is important that the diagnosis is suspected early, especially in adolescent males who present with recurrent episodes of somnolence, increased appetite, and abnormal behavior, since it most often represents a benign and self-limited entity and does not warrant extensive investigations or treatment. It is also important to distinguish this syndrome from more serious organic and psychiatric diseases with more serious prognoses. The differential diagnosis of this syndrome is discussed and a review of the literature is presented including evidence and hypotheses regarding its pathophysiology.
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Affiliation(s)
- S S Papacostas
- The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
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Müller T, Kuhn W, Börnke C, Büttner T, Przuntek H. Kleine-Levin syndrome and Parkinsonian symptoms--a case report. J Neurol Sci 1998; 157:214-6. [PMID: 9619648 DOI: 10.1016/s0022-510x(98)00087-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
We report the case of a 54-year-old male patient, who developed the symptoms of Kleine-Levin syndrome (KLS) at the age of fifty. Four years later Parkinsonian symptoms (PS) appeared. The possible relationship between both KLS and PS, e.g. regarding neuroendocrinological similarities, will be discussed to explain the subsequent onset of PS after the manifestation of KLS in this patient.
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Affiliation(s)
- T Müller
- Department of Neurology, St. Josef-Hospital, Ruhr-University of Bochum, Germany
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