Images in Sleep MedicineAn adult onset patient with Kleine–Levin syndrome responding to valproate
Introduction
Kleine–Levin (K–L) Syndrome is an episodic disorder of periodic hyper somnolence followed by hyperphagia and hyper sexuality on awakening occurring mostly in adult boys [1], [2]. We are reporting an adult patient who responded satisfactorily to Valproate treatment.
Section snippets
Case report
A 31-year-old male presented with episodes of prolonged “sleep attacks” for two years, initially occurring every 2–4 months but later increasing in frequency to every 1–3 weeks; each episode lasting from 12–18 h. Cessation of “sleep attacks” was followed by hyperphagia where he would eat 2–3 times the size of his usual meals and hyper sexuality manifested by sustained erections and masturbation 2–4 times. He was asymptomatic between episodes. General physical examination, neurological
Image analysis
Rest (lighter areas); Activity (darker areas) pattern in the actigraphy correlates with the sleep-wake period. Note 10 h of sleep on 1/2/98 and 1/3/98; 14 h of sleep on 1/5/98 to 1/6/98; 11 h of sleep on 1/9/98. Also notable are the facts that sleep in the first few days of monitoring during symptomatic periods is not only longer but also irregularly distributed, and in the last 4 days the sleep-wake rhythm has normalized.
Discussion
Kleine–Levin Syndrome has recently been suggested to be due to possible paramedian thalamic dysfunction [3]. The treatment of K-L syndrome has been unsatisfactory except for a few reports of improvement with Lithium. In our patient, there was remarkable response to Valproate supporting the brief report of Crumley [4] and the review by Arnulf et al. [5]. Valproate may be a good alternative to Lithium treatment which has more undesirable side effects than Valproate.
References (5)
Valproic acid for Kleine–Levin syndrome
J Am Acad Child Adolesc Psychiatry
(1997)Peridische Schalafsucht
Mschr Psychiatr Neurol
(1925)