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Kleine Levin Syndrome

A rare form of periodic hypersomnia associated with hyperphagia occurring in males between 10 to 25 years old. Characterized by periods of ravenous appetite alternating with prolonged sleep, as long as 18 hours, along with behavioral disturbances, impaired thought processes, and hallucinations. Acute illness or fatigue may precede an episode which may occur as often as several times a year.

Between attacks the person recovers completely and the sleep periods usually disappear in adult age. This syndrome may easily be confused for other neurological, metabolical or psychiatric disease.

Also known as Critchley's Syndrome, Kleine-Levin-Critchley Syndrome, Kleine-Levin Hibernation Syndrome, Familial Hibernation Syndrome, Periodic Somnolence and Morbid Hunger. The main symptoms are:

The disorder primarily affects adolescent males aged 15 - 25 years.

When awake, affected individuals may exhibit irritability, lack of energy (lethargy), and/or lack of emotions (apathy).

They may also appear confused (disoriented) and experience hallucinations

When present, symptoms may persist for days to weeks.

Symptoms cyclical.

Associated Features:

Hypersomnia.
Hypersexual behavior.
Excessive eating.
Confusion.
Irritability.
Restlessness.
Euphoria.
Hallucinations.
Delusions.
Schizophreniform states

Differential Diagnosis:

Some disorders display similar or sometimes even the same symptom. The clinician, therefore, in his diagnostic attempt, has to differentiate against the following disorders which one needs to be ruled out to establish a precise diagnosis.

Mood Disorders.
Sleepiness during the premenstrual period in teenaged girls.

Cause:

Onset is typically around adolescence to the late teens. The disorder is 4 times more common in males than in females. Symptoms may be related to malfunction of the hypothalamus, the part of the brain that governs appetite and sleep. In most cases, the symptoms eventually disappear with advancing age.

Treatment:

There is no definitive treatment for Kleine-Levin Syndrome.

Pharmacotherapy [ See Psychopharmacology Section ] :

Stimulants:
Amphetamines.
Methylphenidate.
Modafinil.
Lithium.
Carbamazepine.

Responses to treatment have often been limited.

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