Kleine-Levin Syndrome

Symptoms similar to Kleine-Levin syndrome in a patient with basilar artery occlusion: a case report and literature review

Introduction

Kleine-Levin syndrome (KLS) is a rare disorder characterized by recurrent periodic hypersomnia, cognitive disturbances, hyperphagia, and hypersexuality. Although many factors have been associated with its occurrence, little is known about treatment. Herein, we present a case of symptoms similar to KLS thought to be related to vascular occlusion disease.

Case description

An 81-year-old woman was admitted to the hospital due to recurring episodes of disturbance of consciousness, cognitive disorder, and hyperphagia for 18 years. She was diagnosed with KLS and basilar artery occlusion. Endovascular and antithrombotic therapy was initiated, and her symptoms fully resolved within 2 weeks of treatment initiation.

Conclusion

KLS has diverse clinical presentations and demonstrates variable therapeutic responses. Vascular disease or blood flow disorder may be one possible factor for this disease. This case underscores the need for further research into the etiology and pathogenesis of KLS to promote evidence-based approaches for its diagnosis and treatment.

Neuroimaging in the Rare Sleep Disorder of Kleine-Levin Syndrome: A Systematic Review

Kleine-Levin syndrome (KLS) is characterized by episodes of hypersomnia. Additionally, these patients can present with hyperphagia, hypersexuality, abnormal behavior, and cognitive dysfunction. Functional neuroimaging studies such as fMRI-BOLD, Positron Emission Tomography (PET) or SPECT help us understand the neuropathological bases of different disorders. We conducted a systematic review to investigate the neuroimaging features of KLS patients and their clinical correlations. This systematic review was conducted by following the Meta-Analysis of Observational Studies in Epidemiology (MOOSE) and PRISMA protocol reporting guidelines. We aim to investigate the clinical correlation with neuroimaging among patients with KLS. We included only studies written in the English language in the last 20 years, conducted on humans; 10 studies were included. We excluded systematic reviews, metanalysis, and case reports. We found that there are changes in functional imaging studies during the symptomatic and asymptomatic periods as well as in between episodes in patients with K.L.S. The areas most reported as affected were the hypothalamic and thalamic regions, which showed hypoperfusion and, in a few cases, hyperperfusion; areas such as the frontal, parietal, occipital and the prefrontal cortex all showed alterations in cerebral perfusion. These changes in cerebral blood flow and regions vary according to the imaging (SPECT, PET SCAN, or fMRI) and the task performed while imaging was performed. We encountered conflicting data between studies. Hyper insomnia, the main feature of this disease during the symptomatic periods, was associated with decreased thalamic activity. Other features of K.L.S., such as apathy, hypersexuality, and depersonalization, were also correlated with functional imaging changes. There were also findings that correlated with working memory deficits seen in this stage during the asymptomatic periods. Hyperactivity of the thalamus and hypothalamus were the main features shown during the asymptomatic period. Additionally, functional imaging tends to improve with a longer course of the disease, which suggests that K.L.S. patients outgrow the disease. These findings should caution physicians when analyzing and correlating neuroimaging findings with the disease.

Periodic hypersomnolence in a young female patient: a case report and literature review

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.