A pre-pubertal girl with Kleine-Levin syndrome

Abstract

Kleine-Levin syndrome is an exceptionally rare disorder characterized by recurrent episodes of hypersomnia associ- ated with varying degrees of behavioral or cognitive disturbances and compulsive eating behavior. The disorder occurs pre- dominantly in adolescent males with a benign clinical course and spontaneous remission as long as other neurological or psy- chiatric diseases are excluded. A viral or an autoimmune etiology has been suggested as up to 70% of patients have flu-like symptoms at the onset of their symptoms. In this report, we present a 9-year-old female patient with this rare disorder and review the relevant pediatric literature. She was previously healthy and presented with a 1-month history of generalized fatigue, ex- cessive sleep and behavioral change. She would sleep for most of the day even while sitting and would resist being awakened. During brief periods of wakefulness, her mood will fluctuate from apathy to anger, sadness and aggression for minimal reasons. She would eat and drink excessively with a notable weight gain. Clinical examination and detailed investigations, including brain computerized tomography scan and electroencephalography were within normal limits. Remarkable improvement of her symptoms was noted after initiating methylphenidate and carbamazepine. We conclude that Kleine-Levin syndrome is an in- teresting rare disorder that needs to be diagnosed after excluding other causes of excessive sleep. Early recognition would result in appropriate treatment and shortened period of hospitalization.