Kleine-Levin Syndrome | Drauzio Varella





In Kleine-Levin syndrome, also known as Sleeping Beauty syndrome, bouts of hypersomnia can last for hours, days, or weeks.

Kleine-Levin syndrome (SKL), also known as “Sleeping Beauty syndrome”, was named after the central character of a German fairy tale who, by the imposition of an evil sorceress, was condemned to sleep soundly until that a prince would wake her up with a kiss of love.

In medicine, the name designates a rare neurological disorder, difficult to diagnose, which came to be known as Kleine-Levin syndrome, in honor of the two scientists who endeavored to describe the condition, which was classified as one of different types of hypersomnia.

See also: Sleep disorders

Among the main characteristics of this syndrome of unknown origin, the following stand out: 1) the manifestation of recurrent and remitting episodes of excessive daytime or nighttime sleepiness, which tend to disappear over the years; 2) extreme resistance to waking up and staying awake during the day; 3) little-known disorder that makes it difficult to define the diagnosis pertinent to the condition; 4) the intensity of the crisis diminishes over time; 5) favorable prognosis, even though the path to a definitive cure is not yet known; 6) outbreaks, in general, persist for about ten continuous days and may reappear every three or four months a year.

Hypersomnia crises can last for hours, days or weeks, and are accompanied by uncontrollable cognitive and behavioral changes, which compromise the quality of life of the person and those who live with them, as well as impair the social, affective and professional performance of patients. of the condition.

Kleine-Levin syndrome can manifest at any age, but it especially affects male adolescents and young adults. Only occasionally are women and the elderly affected by the disorder, which is associated with the classic trio of the following symptoms: hypersomnia (deep sleepiness), hyperphagia (compulsive eating), and overt and aggressive sexual hyperactivity.

As there is still no known effective treatment that promotes the complete cure of the syndrome, the clinical follow-up of patients with the disorder has shown that the disorder can disappear spontaneously, without medication or special care, around the age of 35/40.

Causes of Kleine-Levin syndrome

Kleine-Levin syndrome is a disorder whose cause has not yet been identified (hence it is called idiopathic or primary). Several hypotheses have already been raised that try to clarify the origin of the disorder, starting with infection by a type of virus that reappears from time to time.

Genetic, autoimmune and hereditary factors, head injuries and a strong stress load are other possible causes of the syndrome, which are still being studied.

Some research suggests that the presence of functional changes in certain areas of the brain (hypothalamuslimbic system, thalamus and frontotemporal cortex, for example) may be related to the regulation of sleep and emotions in patients with the syndrome.

Currently, the trend is to admit that the condition may have a genetic component and be associated with immunological and environmental factors.

Symptoms of Kleine-Levin syndrome

Recurrent bouts of excessive sleepiness, food cravings, and complete sexual disinhibition are the main signs of Kleine-Levin syndrome.

At the onset of the crisis, the hypersomnia episode can last for hours and hours of intense, uninterrupted sleep. The person only wakes up after a lot of effort, to use the bathroom and eat uncontrollably

Called “sleep inertia,” this transition phase from sleep to wakefulness can be slow and can be quite confusing.

Even during crises, in the short periods when she is really awake, drastic changes in behavior can occur, marked by extreme tiredness, apathy, mental confusion, impaired attention and concentration, memory lapses, irritability, lack of control over food, loss of inhibition sex and even hallucinations.

Another frequent complaint, in these cases, is the difficulty in distinguishing the dream from reality, when the person tries to remember what happened while sleeping (mild amnesia). It is also common that, during waking hours, there are manifestations of compulsive behavior, emotional lability and patients are extremely sensitive to noise and light.

It is important to note that, between one crisis and another, the person returns to normal behavior and resumes routine activities, as if he had never been affected by this sleep disorder. On the contrary, they seem to be doing well, enjoying perfect physical and mental health, and only a minority show signs of more persistent psychiatric disorders.

See also: Sleep deprivation

Diagnosis of Kleine-Levin syndrome

From a clinical point of view, the diagnosis of Kleine-Levin syndrome of unidentified cause is made by exclusion, preferably by a multidisciplinary team, led by a neurologist.

Therefore, laboratory blood tests and imaging tests (MRIultrasound, computed tomography) have been shown to be useful to establish the differential diagnosis with other pathologies that present similar symptoms.

In any case, the most reliable test for diagnosing hypersomnia, in general, and Kleine-Levin syndrome, in particular, continues to be polysomnography, a non-invasive procedure that allows the assessment of sleep quality and the diagnosis of possible associated disorders.

To complete the diagnosis, it is necessary that the symptoms persist for at least one month and have a negative impact on the patient’s quality of life.

Treatment of Kleine-Levin syndrome

To date, there is no known effective treatment for Kleine-Levin syndrome, a rare disorder with low prevalence and unknown cause. Faced with such evidence, the attention of scholars has turned to the control and relief of symptoms. It is already known that it is possible to improve the quality of life of patients with the condition, using certain stimulant drugs, such as amphetamines and antidepressants, which have shown some effectiveness in similar clinical situations and in the implicit psychological symptoms.

With regard to pharmacological resources, mood stabilizers and anticonvulsants can be part of the therapeutic regimen provided for behavioral disorders related to the syndrome. The prescription of lithium-based drugs during the duration of crises has already been tested and proved to have a beneficial effect.

During crises, it is part of the treatment to let the person sleep, without interference, for as long as he/she considers necessary.

However, despite the different approaches, the objective of the treatment remains the same: to reduce periods of excessive sleepiness during the day and to extend, as much as possible, those in which the person is able to remain fully awake.

Unfortunately, effective treatment for the syndrome remains elusive. However, current studies suggest that the popularly known as Sleeping Beauty syndrome is not as benign as previously thought. The current trend is to admit that the condition has a genetic origin associated with immunological and environmental factors.

Frequently asked questions about Kleine-Levin syndrome

What are the symptoms of Kleine-Levin syndrome?

Recurrent bouts of excessive sleepiness, food cravings, and complete sexual disinhibition are the main signs of Kleine-Levin syndrome. During seizures, during periods when the person is awake, drastic changes in behavior, extreme tiredness, apathy, mental confusion, impaired attention and concentration, memory lapses, irritability, lack of control over eating, loss of sexual inhibition and even hallucinations.

In addition, there are also difficulties in distinguishing dreams from reality and manifestations of compulsive behavior, emotional lability and sensitivity to noise and light.

What are the causes of Kleine-Levin syndrome?

Kleine-Levin syndrome is a disorder with an unidentified cause. Currently, the trend is to admit that the condition may have a genetic component and be associated with immunological and environmental factors.

About Jenni Smith

She's our PC girl, so anything is up to her. She is also responsible for the videos of Play Crazy Game, as well as giving a leg in the news.

Check Also

Psychiatrist Vitor Pordeus gives a lecture on mental health and addresses the work of Nise da Silveira

The Municipality of Muriaé, through the Municipal Health Department, held on Friday night (13), in …