Effects of treatment with lithium in a case of Kleine–Levin without compulsive eating

Abstract

Kleine–Levin syndrome without compulsive eating (KLS WOCE) is characterized by recurrent hypersomnia with cognitive abnormalities but not compulsive eating. The disease is typically described in adolescents. Here, we present a 2 year follow-up case of KLS WOCE in a middle age woman with extreme hypersomnia documented by actigraphy and the effects of treatment with lithium carbonate. This is a 58-year-old woman with no personal or familial psychiatric past history. She reported normal sleep habits. She started experiencing strong episodes of recurrent hypersomnia one year before this study. No trigger was identified. A video-polysomnography followed by MSLT implemented before, showed no significant findings. MRI, TAC and EEG were normal. A history of 5 years of little sleepiness which began just after menopause was reported. A video-polysomnography and a complete neuropsychological examination was conducted between episodes. Sleep logs for 15 consecutive months and two actigraphy studies of one month of duration each, before and after lithium carbonate treatment, monitored episodes of hypersomnia and inter-crisis. At the moment of the first visit she presented episodes of 3 to 7 days of extreme hypersomnia followed by several days of insomnia or normal sleep for 15 to 30 days. During episodes she presented impaired speech and concentration, inability to make a decision and impairment of memory. Some symptoms of depression and anxiety were also observed. She also reported some dysautonomic features such as nauseating body or hypotension. Interepisodes, neuropsychological studies showed little problems in executive functions and attention and memory functions. She also showed some difficulties in verbal recognition. Video polysomnography was completely normal: Efficacy: 87%. No respiratory or movement events occurred. Actigraphy and sleep logs documented a short cycle length before treatment. Lithium carbonate dramatically reduced the frequency, duration and intensity of episodes. Significant reduction began one month after the beginning of treatment even when secondary effects were observed much earlier. The improvement was maintained for the next 12 months. At the time of this writing episodes of hypersomnia rarely occur once a month for 4 to 6 h and their intensity is much lower. We present the efficacy of treatment with lithium in a middle-age woman with KLS WOCE as documented by actigraphy. Even when some symptoms decrease in severity and duration with repeated episodes, the efficacy of treatment is clear in this follow-up in order to the temporal relationship and intensity of reduction of the symptoms.