Case report use of valproate in kleine levin syndrome

Case report use of valproate in kleine levin syndrome

He was noticed to have frequent movements of legs during sleep, but had no history of aura, snoring, sleep paralysis, vivid dreams, sleep fragmentation, or sudden drop attacks. Head trauma, including a knock-out during boxing Smolik and Roth, ; Will et al. The need for sleep was very intense and at the end of an episode, a short-lasting insomnia was noted in few cases. Additionally, some patients appear depressed during episodes and temporarily hypomanic upon recovery. Similar to our patient, anticonvulsants like valproate are the preferred treatment for KLS patient, and may also offer benefits in case of comorbid epilepsy. Numerous KLS case-reports have been published since, speculating on the yet unknown cause of this condition. These were evident when interviewed during episodes such as abnormal responses to question , or reported on subsequent interviews, as a recall of a previous episode. All these abnormalities were transient and reversed after episodes. Gen Hosp Psychiatry.

In conclusion, lithium monotherapy in a low dose could be an effective treatment in patients with KLS especially children. The hypothalamus has a role in sleep, appetite, and sexual behaviors. The age of onset of KLS ranged from 10 to 25 years the majority being in the second decadeas was evident in our patient.

Unlike the index case, secondary KLS is more common and occurs following triggering stimuli, such as infection or fever, alcohol or marijuana intake, head trauma, sleep deprivation, stress, psychological distress, physical exertion, menstruation, or lactation. KLS patients show preference to sweet foods as also seen in this case.

Not much is known about its long-term management; however, many reports suggest the usefulness of anticonvulsants and lithium for the same.

Between episodes, majority of patients were described as totally normal.

kleine levin syndrome mayo

A study recruited more than new cases sequentially in a single year which was comparable with the bulk of previously reported cases. Routine investigations complete blood counts, liver and renal function tests, urine routine and microscopy, and chest X-rayelectroencephalography EEGthyroid profile, and magnetic resonance imaging MRI brain were performed to rule out the possible organic cause, all of which were found to be normal.

Additionally, some patients appear depressed during episodes and temporarily hypomanic upon recovery.

kleine levin syndrome usmle

A provisional diagnosis of KLS was kept. Hence, in view of seizure disorder and lack of response, neurologist's consultation was sought, who opined to start antiepileptic medication. Indian J Psychiatry. Crumley FE.

Kls triggers

A case of Kleine-levine syndrome. One systematic review of cases of KLS reported the use of lithium in only 29 cases, out of which 12 had no more relapses. Derealization, Hallucination, and Delusion A feeling of unreality surroundings seemed wrong, distorted or unreal, as in a dream or of disconnected thinking during episodes was reported by most patients and felt to be the most specific symptom of the syndrome. He again had a high-grade fever. Unlike the index case, secondary KLS is more common and occurs following triggering stimuli, such as infection or fever, alcohol or marijuana intake, head trauma, sleep deprivation, stress, psychological distress, physical exertion, menstruation, or lactation. Altered perception was always present and could affect all senses, with feelings that things were unreal, dreamlike. The agents responsible for the first infection were rarely identified and included Epstein—Barr virus and varicella—zoster virus Salter and White, , Asian influenza virus Garland et al. It was precipitated most frequently by infections In a few cases, a large or first alcohol consumption or marijuana use on an evening was followed by the first episode the following morning Wilkus and Chiles, ; Chiles and Wilkus, ; Mayer et al. His hemogram, renal functions, liver functions, blood sugar, routine urine, thyroid functions were within normal limits and chest X-ray, electrocardiography, electroencephalography EEG , and magnetic resonance imaging brain were normal. There was no disturbance in language, speech, nor did he have a hypersexual behavior. Finally, the large recent series of 30 patients by Dauvilliers et al. There was no history or family history of any major medical or psychiatric illness. One study reported a median duration of illness of 4—8 years while median duration of the episode is 10 days.
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