Indian Journal of Sleep Medicine

Register      Login

VOLUME 5 , ISSUE 4 ( October-December, 2010 ) > List of Articles

REVIEW ARTICLE

Revisiting Kleine-Levin Syndrome – a case report and review

Jyoti Krishna, Ai-Ping Chua, Prakash Kotagal, Chua Ai Ping

Keywords : Hypersomnia, Episodic, Recurrent, Multiple sleep latency test, Polysomnogram, Carbamazepine, Hyperphagia, Kleine-Levin Syndrome.

Citation Information : Krishna J, Chua A, Kotagal P, Ping CA. Revisiting Kleine-Levin Syndrome – a case report and review. Indian Sleep Med 2010; 5 (4):111-115.

DOI: 10.5005/ijsm-5-4-111

License: NA

Published Online: 01-07-2018

Copyright Statement:  NA


Abstract

A 15 year-old girl who was previously well presented with severe recurrent episodic hypersomnia associated with abnormal behavior and hyperphagia after recovery from a mild upper respiratory tract infection (URTI). Physical examination was unremarkable with normal blood tests, brain imaging and electroencephalogram (EEG). A multiple sleep latency test (MSLT) during a typical episode showed moderate hypersomnolence in contrast to a normal MSLT performed an the interval between episodes. Clinical features were consistent with Kleine-Levin syndrome (KLS). She was started on carbamazepine treatment after failing a trial of methylphenidate and is currently being followed up for her symptoms.


PDF Share
  1. Kleine W. Periodische Schlafsucht. Monatsschrift fur Psychiatrie und Neurologie 1925; 57:285–320. Levin M. Periodic somnolence and morbid hunger: a new syndrome. Brain 1936; 59:494-504.
  2. American Academy of Sleep Medicine. International classification of sleep disorders, 2nd ed: Diagnostic and coding manual, American Academy of Sleep Medicine, Westchester, IL 2005.
  3. Arnulf I, Lin L, Gadoth N, File J, Lecendreux M, Franco P, Zeitzer J, Lo B, Faraco JH, Mignot E. Kleine-Levin syndrome: a systematic study of 108 patients. Ann Neurol. 2008 Apr; 63(4):482-93.
  4. Gadoth N, Kesler A, Vainstein G, Peled R, Lavie P. Clinical and polysomnographic characteristics of 34 patients with Kleine-Levin syndrome. J Sleep Res 2001 Dec; 10(4):337–41.
  5. Huang YS, Guilleminault C, Kao PF, Liu FY. SPECT findings in the Kleine-Levin syndrome. Sleep 2005; 28:955–960.
  6. Glasson E, Bower C, Petterson B, et al. Perinatal factors and the development of autism: a population study. Arch Gen Psychiatry 2004; 61:618–627.
  7. Downie A, Frisk V, Jakobson L. The impact of periventricular brain injury on reading and spelling abilities in the late elementary and adolescent years. Child Neuropsychol 2005; 11:479–495.
  8. Isohanni M, Murray G, Jokelainen J, et al. The persistence of developmental markers in childhood and adolescence and risk for schizophrenic psychoses in adult life. A 34-year follow-up of the Northern Finland 1966 birth cohort. Schizophr Res 2004; 71(2-3):213–225.
  9. Dauvilliers Y, Mayer G, Lecendreux M, et al. Kleine-Levin syndrome: an autoimmune hypothesis based on clinical and genetic analyses. Neurology 2002; 59:1739 –1745.
  10. Salter MS, White PD. A variant of Kleine-Levin syndrome precipitated by both Epstein-Barr and varicella-zoster virus infections. Biological Psychiatry 1993; 33:388–90.
  11. Snider LA, Swedo SE. Post-streptococcal autoimmune disorders of the central nervous system. Curr Opin Neurol. 2003 Jun; 16(3):359-65.
  12. Kirvan CA, Swedo SE, Snider LA, Cunningham MW. Antibody-mediated neuronal cell signaling in behavior and movement disorders. J Neuroimmunol 2006; 179:173-9.
  13. Chesson A, Levine S, Kong LS, Lee S. Neuroendocrine evaluation in Kleine-Levin Syndrome: Evidence of reduced dopaminergic tone during periods of hypersomnolence. Sleep 1991; 14:226–32.
  14. Koerber RK, Torkelson R, Haven G, Donaldson J, Cohen SM, Case M. Increased cerebrospinal fluid 5-hydroxytryptamine and 5-hydroxyindoleacetic acid in Kleine-Levin syndrome. Neurology 1984; 34:1597-600.
  15. Russel J, Grunstein R. Kleine-Levin Syndrome: a case report. The Australian and New Zealand Journal of Psychiatry 1992; 26(1):119–23.
  16. Oliveira MM, Conti C, Saconato H, Fernandes do Prado G. Pharmacological treatment for Kleine-Levin Syndrome. Cochrane Database Syst Rev. 2009 Apr 15; (2):CD006685.
  17. Goldberg MA. The treatment of Kleine-Levin syndrome with lithium. Can J Psychiatry 1983;28:491– 493. Kellet J. Lithium prophylaxis of periodic hypersomnia. British Journal of Psychiatry 1977; 130:312–6.
  18. Smolik P, Roth B. Kleine-Levin syndrome etiopathogenesis and treatment. ActaUniversitatis Carolinae. Medica. Monographia 1988; 128:5–94.
  19. Poppe M, Friebel D, Reuner U, Todt H, Koch R, Heubner G. The Kleine-Levin syndrome – effects of treatment with lithium. Neuropediatrics 2003; 34:113–9.
  20. Adlakha A, Chokroverty S. An adult onset patient with Kleine-Levin syndrome responding to valproate. Sleep Med. 2009 Mar; 10(3):391-3.
  21. Mukaddes NM, KoraME, Bilge S. Carbamazepine for Kleine-Levin syndrome. Journal of the American Academy of Child and Adolescent Psychiatry 1999; 38:791–2.
  22. El Hajj T, Nasreddine W, Korri H, Atweh S, Beydoun A. A case of Kleine-Levin syndrome with a complete and sustained response to carbamazepine. Epilepsy Behav. 2009 Jul; 15(3):391-2.
  23. Chaudhry HR. Clinical use of moclobemide in Kleine-Levin syndrome. British Journal of Psychiatry 1992; 161:720.
  24. Itokawa K, Fukui M, Ninomiya M, Yamamoto T, Imabayashi E, Tamura N, Matsuda H, Araki N. Gabapentin for Kleine- Levin syndrome. Intern Med. 2009; 48(13):1183-5.
  25. Gallinek A. The Kleine-Levin syndrome: hypersomnia, bulimia, and abnormal mental states. World Neurology 1962; 3:235–43.
  26. Justo LP, Calil HM, Prado-Bolognani SA, Muszkat M. Kleine- Levin syndrome:interface between neurology and psychiatry. Arq Neuropsiquiatr. 2007; 65(1):150-2.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.