1
|
Arnulf I, Dodet P, Leu-Semenescu S, Maranci JB. Idiopathic hypersomnia and Kleine-Levin syndrome. Rev Neurol (Paris) 2023; 179:741-754. [PMID: 37684104 DOI: 10.1016/j.neurol.2023.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/10/2023]
Abstract
Idiopathic hypersomnia (IH) and Kleine-Levin syndrome (KLS) are rare disorders of central hypersomnolence of unknown cause, affecting young people. However, increased sleep time and excessive daytime sleepiness (EDS) occur daily for years in IH, whereas they occur as relapsing/remitting episodes associated with cognitive and behavioural disturbances in KLS. Idiopathic hypersomnia is characterized by EDS, prolonged, unrefreshing sleep at night and during naps, and frequent morning sleep inertia, but rare sleep attacks, no cataplexy and sleep onset in REM periods as in narcolepsy. The diagnosis requires: (i) ruling out common causes of hypersomnolence, including mostly sleep apnea, insufficient sleep syndrome, psychiatric hypersomnia and narcolepsy; and (ii) obtaining objective EDS measures (mean latency at the multiple sleep latency test≤8min) or increased sleep time (sleep time>11h during a 18-24h bed rest). Treatment is similar to narcolepsy (except for preventive naps), including adapted work schedules, and off label use (after agreement from reference/competence centres) of modafinil, sodium oxybate, pitolisant, methylphenidate and solriamfetol. The diagnosis of KLS requires: (i) a reliable history of distinct episodes of one to several weeks; (ii) episodes contain severe hypersomnia (sleep>15h/d) associated with cognitive impairment (mental confusion and slowness, amnesia), derealisation, major apathy or disinhibited behaviour (hypersexuality, megaphagia, rudeness); and (iii) return to baseline sleep, cognition, behaviour and mood after episodes. EEG may contain slow rhythms during episodes, and rules out epilepsy. Functional brain imaging indicates hypoactivity of posterior associative cortex and hippocampus during symptomatic and asymptomatic periods. KLS attenuates with time when starting during teenage, including less frequent and less severe episodes. Adequate sleep habits, avoidance of alcohol and infections, as well as lithium and sometimes valproate (off label, after agreement from reference centres) help reducing the frequency and severity of episodes, and IV methylprednisolone helps reducing long (>30d) episode duration.
Collapse
Affiliation(s)
- I Arnulf
- Sorbonne Université, Paris, France; Centre de Référence des narcolepsies et hypersomnies rares, Service des pathologies du sommeil, Hôpital Pitié-Salpêtrière, AP-HP Sorbonne Université, Paris, France; Institut du Cerveau (ICM), Paris Brain Institute, Paris, France.
| | - P Dodet
- Centre de Référence des narcolepsies et hypersomnies rares, Service des pathologies du sommeil, Hôpital Pitié-Salpêtrière, AP-HP Sorbonne Université, Paris, France; Institut du Cerveau (ICM), Paris Brain Institute, Paris, France
| | - S Leu-Semenescu
- Centre de Référence des narcolepsies et hypersomnies rares, Service des pathologies du sommeil, Hôpital Pitié-Salpêtrière, AP-HP Sorbonne Université, Paris, France; Institut du Cerveau (ICM), Paris Brain Institute, Paris, France
| | - J B Maranci
- Sorbonne Université, Paris, France; Centre de Référence des narcolepsies et hypersomnies rares, Service des pathologies du sommeil, Hôpital Pitié-Salpêtrière, AP-HP Sorbonne Université, Paris, France; Institut du Cerveau (ICM), Paris Brain Institute, Paris, France
| |
Collapse
|
2
|
Bruni O. Approach to a sleepy child: Diagnosis and treatment of excessive daytime sleepiness in children and adolescents. Eur J Paediatr Neurol 2023; 42:97-109. [PMID: 36608412 DOI: 10.1016/j.ejpn.2022.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 12/08/2022] [Accepted: 12/27/2022] [Indexed: 01/01/2023]
Abstract
The aim of this review is to give updated information to pediatric neurologists on the correct diagnostic approach and treatment of excessive daytime sleepiness (EDS) in children and adolescents. Due to the change in the society habits, EDS is becoming an emerging problem for the health system. At the present there are few articles specifically devoted to the evaluation of EDS. EDS is often reported in several manuscripts as a side effect of other sleep disorders (obstructive sleep apnea, circadian disorders, etc.) or of the use of drugs or of the substance abuse or as a consequence of bad sleep habits and poor sleep hygiene. EDS, especially in children, may manifest with paradoxical symptoms like hyperactivity, inattention, and impulsiveness. However, common sign of EDS in children are the propensity to sleep longer than usual, the difficulty waking up in the morning, and falling asleep frequently during the day in monotonous situation. The diagnosis should include subjective (sleep diaries, questionnaires) and objective (polysomnography, multiple sleep latency test, etc.) instruments to avoid misdiagnosis. Narcolepsy is the most studied central disorder of hypersomnolence, and it is a predominantly pediatric disease with a peak age of onset in prepuberty but the diagnosis is often delayed especially in mild forms. The early and correct treatment of narcolepsy and of other form of EDS is extremely important since late and inappropriate treatments can affect the psychosocial development of the children and adolescents.
Collapse
Affiliation(s)
- Oliviero Bruni
- Department of Developmental and Social Psychology, Sapienza University, Via dei Marsi, 78-00185, Rome, Italy.
| |
Collapse
|
3
|
An Update on Kleine-Levin Syndrome. CURRENT SLEEP MEDICINE REPORTS 2023; 9:35-44. [PMID: 36590182 PMCID: PMC9793345 DOI: 10.1007/s40675-022-00246-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2022] [Indexed: 12/28/2022]
Abstract
Purpose of Review Kleine-Levin syndrome (KLS) is a rare relapsing-remitting sleep disorder distinguished by recurrent periods of severe hypersomnia accompanied by cognitive, mood, and behavioral changes. This review focuses mainly on the most recent developments and articles concerning this illness in the preceding five years while attempting to provide a basic overview of KLS. Recent Findings Genetic links were reported in some patients with KLS, like variation in TRANK1 in a worldwide case-control genome-wide association in patients with KLS, in addition to several uncommon variations in the LMOD3 gene, some of which are likely to be pathogenic, discovered by linkage analysis and exome sequencing in a sizable Saudi Arabian family with KLS and a European cohort of KLS patients. Additionally, recent data indicate that the amplitude of the circadian active/rest cycles significantly decreased during hypersomnia attacks, but during asymptomatic periods, it did not differ significantly from the controls. Moreover, patients with KLS are at a higher risk of developing emerging psychiatric disorders during follow-up. Recent data also points to possible discoveries of diagnostic-potential dysregulated proteomic patterns in KLS. Finally, new data suggest that functional imaging studies are often abnormal in KLS both during and between episodes. Summary KLS is an uncommon, severe, and uniform illness. When it comes to the diagnosis and treatment of KLS, these characteristics offer both opportunities and challenges. Over the past five years, some promising work has appeared in genetics, functional imaging, and biomarker identification; nevertheless, these areas still need more focus to advance the detection and treatment of patients suffering from KLS.
Collapse
|
4
|
Comsa M, Anderson KN, Sharma A, Yadav VC, Watson S. The relationship between sleep and depression and bipolar disorder in children and young people. BJPsych Open 2022; 8:e27. [PMID: 35027099 PMCID: PMC8811784 DOI: 10.1192/bjo.2021.1076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Sleep difficulties are often reported in practice, and are part of the diagnostic criteria for depression and bipolar disorder. AIMS To inform the understanding of the relationship between sleep and both depression and bipolar disorder. METHOD We conducted a narrative literature review of affective disorders and sleep difficulties in children and young people. RESULTS Specific sleep disorders, such as parasomnias, narcolepsy and sleep-related movement disorders, are associated with depression, whereas insomnia, obstructive sleep apnoea and circadian rhythm disorders are associated with both depression and bipolar disorder in children and young people. Conversely, children and young people with depression can present with a number of sleep difficulties, and these are associated with higher depression severity and greater fatigue, suicidal ideation, physical complaints, pain and decreased concentration. Sleep disturbances among adolescents with bipolar disorder can affect the severity of depressive and manic symptoms, are a poor prognostic indicator and have been associated with social and academic impairment. Antidepressants and antipsychotics can directly affect sleep architecture, which clinicians need to be aware of. Non-pharmacological interventions for sleep problems could prevent and/or minimise the risk of relapse in affective disorders. CONCLUSIONS Sleep difficulties can occur before, during and after an episode of depression or bipolar disorder, and have a higher prevalence in affective disorders compared with the general population. A multi-modal approach would include the treatment of both the affective and specific sleep disorder. Further research is needed in this field to understand the impact of combined interventions on clinical outcomes.
Collapse
Affiliation(s)
- Monica Comsa
- Child and Adolescent Mental Health Service, Cumbria Northumberland, Tyne and Wear NHS Foundation Trust, UK
| | | | - Aditya Sharma
- Translational and Clinical Research Institute, Newcastle University, UK; and Child and Adolescent Mental Health Service, Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, UK
| | - Vanishri C Yadav
- Child and Adolescent Mental Health Service, Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, UK
| | - Stuart Watson
- Translational and Clinical Research Institute, Newcastle University, UK; and Specialist Services, Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, UK
| |
Collapse
|
5
|
Kleine-Levin syndrome is associated with birth difficulties and genetic variants in the TRANK1 gene loci. Proc Natl Acad Sci U S A 2021; 118:2005753118. [PMID: 33737391 DOI: 10.1073/pnas.2005753118] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Kleine-Levin syndrome (KLS) is a rare disorder characterized by severe episodic hypersomnia, with cognitive impairment accompanied by apathy or disinhibition. Pathophysiology is unknown, although imaging studies indicate decreased activity in hypothalamic/thalamic areas during episodes. Familial occurrence is increased, and risk is associated with reports of a difficult birth. We conducted a worldwide case-control genome-wide association study in 673 KLS cases collected over 14 y, and ethnically matched 15,341 control individuals. We found a strong genome-wide significant association (rs71947865, Odds Ratio [OR] = 1.48, P = 8.6 × 10-9) within the 3'region of TRANK1 gene locus, previously associated with bipolar disorder and schizophrenia. Strikingly, KLS cases with rs71947865 variant had significantly increased reports of a difficult birth. As perinatal outcomes have dramatically improved over the last 40 y, we further stratified our sample by birth years and found that recent cases had a significantly reduced rs71947865 association. While the rs71947865 association did not replicate in the entire follow-up sample of 171 KLS cases, rs71947865 was significantly associated with KLS in the subset follow-up sample of 59 KLS cases who reported birth difficulties (OR = 1.54, P = 0.01). Genetic liability of KLS as explained by polygenic risk scores was increased (pseudo R 2 = 0.15; P < 2.0 × 10-22 at P = 0.5 threshold) in the follow-up sample. Pathway analysis of genetic associations identified enrichment of circadian regulation pathway genes in KLS cases. Our results suggest links between KLS, circadian regulation, and bipolar disorder, and indicate that the TRANK1 polymorphisms in conjunction with reported birth difficulties may predispose to KLS.
Collapse
|
6
|
Vaillant G, Martin M, Groos E, Larabi IA, Alvarez JC, Arnulf I. A strange New Year's Eve: triggers in Kleine-Levin syndrome. J Clin Sleep Med 2021; 17:329-332. [PMID: 33025902 DOI: 10.5664/jcsm.8858] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
NONE Kleine-Levin syndrome is a rare neurological disease of unknown cause beginning typically during adolescence, characterized by remittent-relapsing episodes of severe hypersomnia associated with cognitive and behavioral disturbances. Triggering factors at Kleine-Levin syndrome onset include infection, sleep deprivation, as well as alcohol, drug, and substance intake. A young woman had 6 episodes over 2 years, including hypersomnia, confusion, derealization, cognitive impairment, anxiety, feeling of being scrutinized, anorexia (and sweet craving once) but no hypersexuality. The first episode started after a party where she experienced a complete, 4-hour-long blackout despite moderate alcohol intake. The patient suspected having been poisoned. Twenty-five months after the party, when Kleine-Levin syndrome was eventually diagnosed, her long hair was analyzed and exogenous γ-hydroxybutyrate was found in the tips (corresponding to the party time). This case illustrates the interest of looking for γ-hydroxybutyrate in the hair when Kleine-Levin syndrome starts after a party.
Collapse
Affiliation(s)
- Garance Vaillant
- National Reference Center for Kleine-Levin Syndrome, Paris, France.,Sorbonne-APHP, Pitie-Salpetriere University Hospital, Sleep Disorders Unit, Paris, France.,Sorbonne University, Paris, France
| | - Marie Martin
- Laboratory of Pharmacology-Toxicology, AP-HP, Raymond Poincaré University Hospital, Garches, France
| | - Elisabeth Groos
- National Reference Center for Kleine-Levin Syndrome, Paris, France.,Sorbonne-APHP, Pitie-Salpetriere University Hospital, Sleep Disorders Unit, Paris, France
| | - Islam-Amine Larabi
- Laboratory of Pharmacology-Toxicology, AP-HP, Raymond Poincaré University Hospital, Garches, France.,Plateforme Spectrométrie de Masse, Versailles Saint-Quentin-en-Yvelines University, Montigny-le-Bretonneux, France
| | - Jean-Claude Alvarez
- Laboratory of Pharmacology-Toxicology, AP-HP, Raymond Poincaré University Hospital, Garches, France.,Plateforme Spectrométrie de Masse, Versailles Saint-Quentin-en-Yvelines University, Montigny-le-Bretonneux, France
| | - Isabelle Arnulf
- National Reference Center for Kleine-Levin Syndrome, Paris, France.,Sorbonne-APHP, Pitie-Salpetriere University Hospital, Sleep Disorders Unit, Paris, France.,Sorbonne University, Paris, France
| |
Collapse
|
7
|
Dudoignon B, Tainturier LE, Dodet P, Bera G, Groos E, Chaumereuil C, Maranci JB, Kas A, Arnulf I. Functional brain imaging using 18F-fluorodeoxyglucose positron emission tomography/computerized tomography in 138 patients with Kleine-Levin syndrome: an early marker? Brain Commun 2021; 3:fcab130. [PMID: 34189461 PMCID: PMC8226192 DOI: 10.1093/braincomms/fcab130] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 04/16/2021] [Accepted: 05/06/2021] [Indexed: 11/12/2022] Open
Abstract
Kleine–Levin syndrome is a rare disorder characterized by relapsing-remitting episodes of severe hypersomnia, cognitive impairment, apathy, derealization and behavioural disturbances. Between episodes, most patients experience normal sleep, mood and behaviour, but they may have some residual abnormalities in brain functional imaging; however, the frequency, localization and significance of abnormal imaging are unknown, as brain functional imaging have been scarce and heterogenous [including scintigraphy 18F-fluorodeoxyglucose positron emission tomography/computerized tomography (FDG-PET/CT) and functional MRI during resting state and cognitive effort] and based on case reports or on group analysis in small groups. Using visual individual analysis of 18F-fluorodeoxyglucose positron emission tomography/computerized tomography at the time of Kleine–Levin syndrome diagnosis, we examined the frequency, localization and clinical determinants of hypo- and hypermetabolism in a cross-sectional study. Among 179 patients with Kleine–Levin syndrome who underwent 18F-fluorodeoxyglucose positron emission tomography/computerized tomography, the visual analysis was restricted to the 138 untreated patients studied during asymptomatic periods. As many as 70% of patients had hypometabolism, mostly affecting the posterior associative cortex and the hippocampus. Hypometabolism was associated with younger age, recent (<3 years) disease course and a higher number of episodes during the preceding year. The hypometabolism was more extensive (from the left temporo-occipital junction to the entire homolateral and then the bilateral posterior associative cortex) at the beginning of the disorder. In contrast, there was hypermetabolism in the prefrontal dorsolateral cortex in half of the patients (almost all having concomitant hypometabolism in the posterior areas), which was also associated with younger age and shorter disease course. The cognitive performances (including episodic memory) were similar in patients with versus without hippocampus hypometabolism. In conclusion, hypometabolism is frequently observed upon individual visual analysis of 18F-fluorodeoxyglucose positron emission tomography/computerized tomography during asymptomatic Kleine–Levin syndrome periods; it is mostly affecting the posterior associative cortex and the hippocampus and is mostly in young patients with recent-onset disease. Hypometabolism provides a trait marker during the first years of Kleine–Levin syndrome, which could help clinicians during the diagnosis process.
Collapse
Affiliation(s)
- Benjamin Dudoignon
- Sorbonne University, Paris Brain Institute (ICM), Inserm UMR-S975, CNRS UMR7225, Paris 75013, France.,Sleep Disorders Unit, National Reference Centre for Kleine-Levin Syndrome, Pitié Salpêtrière University Hospital, APHP, Paris 75013, France
| | - Laure-Eugénie Tainturier
- Nuclear Medicine Department, Hôpitaux Universitaires Pitié-Salpêtrière University Hospital, Sorbonne University, AP-HP, Paris 75013, France.,LIB, INSERM U1146, 75013 Paris, France
| | - Pauline Dodet
- Sorbonne University, Paris Brain Institute (ICM), Inserm UMR-S975, CNRS UMR7225, Paris 75013, France.,Sleep Disorders Unit, National Reference Centre for Kleine-Levin Syndrome, Pitié Salpêtrière University Hospital, APHP, Paris 75013, France
| | - Géraldine Bera
- Nuclear Medicine Department, Hôpitaux Universitaires Pitié-Salpêtrière University Hospital, Sorbonne University, AP-HP, Paris 75013, France.,LIB, INSERM U1146, 75013 Paris, France
| | - Elisabeth Groos
- Sorbonne University, Paris Brain Institute (ICM), Inserm UMR-S975, CNRS UMR7225, Paris 75013, France.,Sleep Disorders Unit, National Reference Centre for Kleine-Levin Syndrome, Pitié Salpêtrière University Hospital, APHP, Paris 75013, France
| | - Charlotte Chaumereuil
- Sorbonne University, Paris Brain Institute (ICM), Inserm UMR-S975, CNRS UMR7225, Paris 75013, France.,Sleep Disorders Unit, National Reference Centre for Kleine-Levin Syndrome, Pitié Salpêtrière University Hospital, APHP, Paris 75013, France
| | - Jean-Baptiste Maranci
- Sorbonne University, Paris Brain Institute (ICM), Inserm UMR-S975, CNRS UMR7225, Paris 75013, France.,Sleep Disorders Unit, National Reference Centre for Kleine-Levin Syndrome, Pitié Salpêtrière University Hospital, APHP, Paris 75013, France
| | - Aurélie Kas
- Nuclear Medicine Department, Hôpitaux Universitaires Pitié-Salpêtrière University Hospital, Sorbonne University, AP-HP, Paris 75013, France.,LIB, INSERM U1146, 75013 Paris, France
| | - Isabelle Arnulf
- Sorbonne University, Paris Brain Institute (ICM), Inserm UMR-S975, CNRS UMR7225, Paris 75013, France.,Sleep Disorders Unit, National Reference Centre for Kleine-Levin Syndrome, Pitié Salpêtrière University Hospital, APHP, Paris 75013, France
| |
Collapse
|
8
|
Arnulf I, Groos E, Dodet P. Speculating on Kleine-Levin Syndrome mechanisms. J Clin Sleep Med 2021; 17:611-612. [PMID: 33416047 DOI: 10.5664/jcsm.9104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Isabelle Arnulf
- Sorbonne University, Paris, France.,National Reference Center for Kleine-Levin Syndrome, Sleep Disorders Unit, Pitie-Salpetriere Hospital, APHP-Sorbonne, Paris, France
| | - Elisabeth Groos
- National Reference Center for Kleine-Levin Syndrome, Sleep Disorders Unit, Pitie-Salpetriere Hospital, APHP-Sorbonne, Paris, France
| | - Pauline Dodet
- National Reference Center for Kleine-Levin Syndrome, Sleep Disorders Unit, Pitie-Salpetriere Hospital, APHP-Sorbonne, Paris, France
| |
Collapse
|
9
|
Cannon L, Van Mater H, Pizoli C. Hypersomnolence in a 17-year-old Boy. Pediatr Rev 2021; 42:S82-S84. [PMID: 33386370 DOI: 10.1542/pir.2019-0229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
10
|
Abstract
There are numerous disorders of known or presumed neurologic origin that result in excessive daytime sleepiness, collectively known as the central disorders of hypersomnolence. These include narcolepsy types 1 and 2, idiopathic hypersomnia, Kleine-Levin syndrome, and hypersomnia due to or associated with medical disease, neurologic disease, psychiatric disease, medications or substances, and insufficient sleep durations. This chapter focuses on the treatment of nonnarcoleptic hypersomnia syndromes, from those that are commonly encountered in neurologic practice, such as hypersomnia due to Parkinson's disease, to those that are exceedingly rare but present with dramatic manifestations, such as Kleine-Levin syndrome. The level of evidence for the treatment of sleepiness in these disorders is generally lower than in the well-characterized syndrome of narcolepsy, but available clinical and randomized, controlled trial data can provide guidance for the management of each of these disorders. Treatments vary by diagnosis but may include modafinil/armodafinil, traditional psychostimulants, solriamfetol, pitolisant, clarithromycin, flumazenil, sodium oxybate, melatonin, methylprednisolone, and lithium.
Collapse
Affiliation(s)
- Lynn Marie Trotti
- Department of Neurology, Emory University School of Medicine, and Emory Sleep Center, Emory Healthcare, 12 Executive Park Dr NE, Atlanta, GA, 30329, USA.
| | - Isabelle Arnulf
- Service des Pathologies du Sommeil, Centre National de Reference des Hypersomnies Rares, Hôpitaux Universitaires Pitié-Salpêtrière, Sorbonne Université, Paris, 75013, France
| |
Collapse
|
11
|
El Otmani H, Amzil R, Abdoh Rafai M, El Moutawakil B. Excellent response to amantadine in Kleine Levin syndrome. Sleep Med 2020; 75:540-541. [PMID: 32917543 DOI: 10.1016/j.sleep.2020.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 07/02/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Hicham El Otmani
- Neurology Department Ibn Rochd University Hospital - Laboratory of Genetics and Molecular Pathology, Faculty of Medicine and Pharmacy of Casablanca, University Hassan II, 20250, Casablanca, Morocco.
| | - Rim Amzil
- Neurology Department Ibn Rochd University Hospital - Laboratory of Genetics and Molecular Pathology, Faculty of Medicine and Pharmacy of Casablanca, University Hassan II, 20250, Casablanca, Morocco.
| | - Mohamed Abdoh Rafai
- Neurology Department Ibn Rochd University Hospital, 20250, Casablanca, Morocco.
| | - Bouchra El Moutawakil
- Neurology Department Ibn Rochd University Hospital - Laboratory of Genetics and Molecular Pathology, Faculty of Medicine and Pharmacy of Casablanca, University Hassan II, 20250, Casablanca, Morocco.
| |
Collapse
|
12
|
Pizza F, Filardi M, Moresco M, Antelmi E, Vandi S, Neccia G, Mazzoni A, Plazzi G. Excessive daytime sleepiness in narcolepsy and central nervous system hypersomnias. Sleep Breath 2019; 24:605-614. [DOI: 10.1007/s11325-019-01867-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 04/30/2019] [Accepted: 05/13/2019] [Indexed: 01/20/2023]
|
13
|
Prévalence de la dépression majeure en France en population générale et en populations spécifiques de 2000 à 2018 : une revue systématique de la littérature. Presse Med 2019; 48:365-375. [DOI: 10.1016/j.lpm.2018.12.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 11/20/2018] [Accepted: 12/04/2018] [Indexed: 11/22/2022] Open
|
14
|
Arnulf I, Groos E, Dodet P. Kleine-Levin syndrome: A neuropsychiatric disorder. Rev Neurol (Paris) 2018; 174:216-227. [PMID: 29606318 DOI: 10.1016/j.neurol.2018.03.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 03/05/2018] [Accepted: 03/05/2018] [Indexed: 10/17/2022]
Abstract
Kleine-Levin syndrome (KLS) is a rare, relapsing-remitting disease that affects mostly adolescents. It is characterized by episodes lasting from 1 to several weeks, and comprises neurological (hypersomnia, confusion, slowness, amnesia) and neuropsychiatric symptoms (derealization and apathy). Some psychiatric symptoms (megaphagia, hypersexuality, anxiety, depressed mood, hallucinations, delusions) arise during episodes, albeit less frequently, while patients are normal between episodes. However, sudden severe (>18h/day of sleep) and recurrent hypersomnia helps to differentiate KLS from other psychiatric mimics. Derealization, the striking feeling of unreality or of being in a dream-like environment, is strongly associated with hypoperfusion of the associative temporoparietal junction cortex, whereas apathy is almost complete loss of autoactivation: teenagers stop using their cell phones and their only spontaneous initiative is to sleep. The cause of KLS is not known, but evidence suggests it could be a recurrent inflammatory encephalitis. Up to 5% of cases are familial, although no abnormal gene has yet been found. Hypersomnia episodes tend to become less frequent and to disappear with advancing age. However, 28% of patients have long-lasting episodes (>30 days), and around 15% have no signs of recovery after >20 years of living with the disorder. Patients' cognitive and psychiatric status should be regularly checked during asymptomatic periods, as 20-40% develop long-term mild cognitive impairment or mood disorders. Lithium therapy is beneficial for reducing episode frequency, and intravenous steroids can reduce the duration of long episodes.
Collapse
Affiliation(s)
- I Arnulf
- Service des pathologies du sommeil, Centre National de Reference des Hypersomnies Rares, Hôpitaux Universitaires Pitié-Salpêtrière, Sorbonne Université, 47-83 boulevard de l'Hôpital, 75651 Paris Cedex 13, France.
| | - E Groos
- Service des pathologies du sommeil, Centre National de Reference des Hypersomnies Rares, Hôpitaux Universitaires Pitié-Salpêtrière, Sorbonne Université, 47-83 boulevard de l'Hôpital, 75651 Paris Cedex 13, France
| | - P Dodet
- Service des pathologies du sommeil, Centre National de Reference des Hypersomnies Rares, Hôpitaux Universitaires Pitié-Salpêtrière, Sorbonne Université, 47-83 boulevard de l'Hôpital, 75651 Paris Cedex 13, France
| |
Collapse
|