Neuroendocrine rhythms in a patient with the Kleine-Levin syndrome

Kleine-Levin syndrome: clues to aetiology

Kleine-Levin syndrome (KLS) is the commonest recurrent sleep disorder, with a prevalence of 1-2 per million population. Clear diagnostic criteria are now defined, but effective treatment remains elusive. The significant body of published literature allows consideration of possible aetiological mechanisms, an understanding of which could guide the development of therapeutic strategies. Functional imaging studies have been inconclusive; although diencephalic abnormalities are a common finding, no consistent pattern has emerged, and these studies have not revealed the mechanism(s) underlying the development of the abnormalities detected. An autoimmune aetiology is consistent with the available data. In this review, we argue that, in order to further our understanding of KLS, there needs to be a co-ordinated international effort to standardise approaches to functional imaging studies, genetic analyses that specifically address the possibility of an autoimmune aetiology, and clinical trials of immunosuppressive therapies.

The "Known Unknowns" of Kleine-Levin Syndrome: A Review and Future Prospects

Kleine-Levin syndrome (KLS) is a rare, homogeneous, debilitating sleep disorder characterized by episodic hypersomnia, cognitive impairment, and behavioral changes. The etiology, pathophysiology, and optimal management of KLS remain uncertain. We identify the 5 key areas requiring urgent attention: KLS immunopathogenesis studies, next-generation genetics, multimodal functional imaging, biomarker discovery, and clinical drug trials. A centralized registry of afflicted individuals must be established. Disease uniformity should make the identification of associated genetic or imaging biomarkers easier, but clinical efforts require laboratory-based research to model the disease and generate preclinical data for clinical translation.

Etiopathogenesis of catatonia: generalizations and working hypotheses

Catatonia has been rediscovered over the last 2 decades as a unique syndrome that consists of specific motor signs with a characteristic and uniform response to benzodiazepines and electroconvulsive therapy. Further inquiry into its developmental, environmental, psychological, and biological underpinnings is warranted. In this review, medical catatonia models of motor circuitry dysfunction, abnormal neurotransmitters, epilepsy, genetic risk factors, endocrine dysfunction, and immune abnormalities are discussed. Developmental, environmental, and psychological risk factors for catatonia are currently unknown. The following hypotheses need to be tested: neuroleptic malignant syndrome is a drug-induced form of malignant catatonia; Prader-Willi syndrome is a clinical GABAergic genetic-endocrine model of catatonia; Kleine-Levin syndrome represents a periodic form of adolescent catatonia; and anti-N-methyl-d-aspartate receptor encephalitis is an autoimmune type of catatonia.

Neuropsychological sequelae in Kleine-Levin syndrome: case report

Kleine-Levin syndrome is characterized by periodic hypersomnia, hyperphagia, sexual disinhibitions and behavioral disturbances. The prognosis is generally benign, with normal cognitive and social functions after the episodes. We describe a typical case of Kleine-Levin syndrome associated with apparent academic decline, neuropsychological sequelae and personality alterations after the second episode of the illness. Further research in the natural history of Kleine-Levin syndrome is needed, for example, to determine whether early intervention would improve long-term prognosis.

The psychiatric symptomatology in Kleine-Levin syndrome

The Kleine-Levin syndrome is a rare disorder with its main symptoms being periodic hypersomnolence and excessive eating accompanied by behavioral changes. The dominance of the behavioral and psychological symptoms may obscure the diagnosis. In this article the diagnostic process and the psychiatric symptomatology of two adolescent male patients with Kleine-Levin syndrome is discussed.

[Review of Kleine-Levin syndrome: toward an integrated approach]

Kleine-Levin syndrome is a characterized by a periodic hypersomnia crisis as well as dietary and variable significant psychic symptoms. Its rarity makes its definition and study complex. Many etiologies have been considered, especially regarding a hypothalamic dysfunction. Physiological, radiologic, anatomical and polysomnographic studies have not shown clearly conclusive results, but the syndrome appears to be related to affective disorders. This hypothesis is supported by the findings of a positive therapeutic response to lithium. However, we are interested in the related psychological factors, whether they are primary or secondary. A clinical case illustrates these factors, and a basic neuropsychiatric intervention concept is proposed.

Kleine-Levin syndrome: a case report

Kleine-Levin Syndrome is an unusual sleep disorder occurring predominantly, but not exclusively, in late adolescent males. A case is described which illustrates some of the difficulties in diagnosis and management.

[Kleine-Levin syndrome. Report of a case]

A case of a 14 year-old boy suffering from Kleine-Levin syndrome is described. The diagnosis was made by symptoms which suggested this disorder: megaphagia, hypersomnia and hypersexuality. A brief review is made emphasizing the pathophysiology, diagnosis and treatment of this syndrome which is frequently misdiagnosed.

Disturbed hypothalamic-pituitary axis in idiopathic recurring hypersomnia syndrome

Disturbed function of the hypothalamic-pituitary axis at adrenal and thyroid levels was found during an episode of hypersomnia in the idiopathic recurring hypersomnia syndrome. These endocrinological abnormalities, abolished ACTH and cortisol responses to insulin-induced hypoglycemia and absent TSH response to TRH, normalised thereafter in the symptom-free interval. These data support the hypothesis that Kleine-Levin syndrome is related to an intermittent hypothalamic dysfunction.

Interepisodic morbidity in Kleine-Levin syndrome

Three patients with Kleine-Levin syndrome had evidence of interepisodic organic brain dysfunction. This is counter to earlier views that the disorder is benign.

Kleine-Levin Syndrome: a female case report and review

The Kleine-Levin Syndrome (KLS) a rare disorder comprising of periodic bouts of hypersomnia and megaphagia is reviewed. The syndrome chiefly affects males. The four accepted female cases in the literature are reviewed and a new female case described. This patient had an IQ in the normal range, unlike the other three female cases where the IQ was measured. She showed an abnormal Cortisol rhythm during both a well and an unwell phase replicating the findings of other workers in some KLS patients. This patient showed normal dexamethasone suppression, a test not previously reported on in KLS. The patient also smoked excessively during the bouts, an occurrence not previously remarked on in this disorder.