Kleine Levin Syndrome: Is it just a sleep disorder? A review of psychiatric features during symptomatic and asymptomatic periods

Main Article Content

Natan Gadoth, MD

Abstract

Kliene Levin syndrome (KLS) is a peculiar sleep disorder of youth, consisting of idiopathic periodic hypersomnia attacks associated with behavioral and sometimes psychiatric symptoms during an attack. With the growing awareness of the syndrome and a steep rise in published cases, it became evident that psychiatric abnormalities may be present before the onset of hypersomnic events, in between events and first appear following years after complete recovery. Those observations suggest that psychiatric morbidity may be part of the symptomatology of KLS. In the present paper the results of a systematic literature search of publications using the key words KLS with psychiatric features, Atypical KLS, KLS like, KLS mimic and sleeping beauty syndrome will be discussed, in attempt to support the view that KLS is indeed a neuropsychiatric disorder and not just a sleep disorder of youth. Moreover, the recognition that KLS might imitate psychosis and other psychiatric disorders in which periodic hypersomnia is present, may decrease the number of KLS patients in whom the correct diagnosis may be delayed or totally missed.

Article Details

How to Cite
GADOTH, Natan. Kleine Levin Syndrome: Is it just a sleep disorder? A review of psychiatric features during symptomatic and asymptomatic periods. Medical Research Archives, [S.l.], v. 11, n. 7.1, july 2023. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/3983>. Date accessed: 22 dec. 2024. doi: https://doi.org/10.18103/mra.v11i7.1.3983.
Section
Review Articles

References

1. Gadoth N, Oksenberg A. Kleine-Levin syndrome; an update and mini-review. Brain Dev. 2017; 39 (8):665-671.
2. Critchley M, Hoffman H. The syndrome of periodic somnolence and morbid hunger (Kleine–Levin syndrome). Br Med J. 1942;1(4230):137-139.
3. Kleine W. Periodische schlafsucht. Monats Psychiatr Neurol. 1925;57:285–320.
4. Levin M. Narcolepsy (Ge´lineau syndrome) and other varieties of morbid somnolence. Arch Neurol Psychiatry 1929; 22 (6) :1172–1200.
5. Lewis NDC. The psychoanalytic approach to the problem of children under twelve years of age. Psychoanal Rev 1926; 13:424–443.
6. Mudgal S, Jiloha RC, Kandpal M, Das A. Sleeping beauty: kleine-levin syndrome. Indian J Psychiatry. 2014 ;56 (3) :298-300.
7. Nebhinani N, Suthar N. Sleeping Beauty Syndrome: A Case Report and Review of Female Cases Reported from India. Indian J Psychol Med. 2017;39 (3) :357-360.
8. Alotaibi W, Mukhtar G. Kleine Levine syndrome (Sleeping beauty): A case report from Saudi Arabia. ES J Case Rep. 2020; 1(4): 1021-2024.
9. Dhage A, Mandaknalli R. Kleine–Levin Syndrome: Sleeping Beauty: A Rare Case Report on Sleep Disorder. Int J Sci Stud. 2015;2 (11) :209-210.
10. Lisk DR . Kleine–Levin syndrome. Practical Neurology. 2009; 9 (1):42-45.
11. Bonkalo A . Hypersomnia: A Discussion of Psychiatric Implications Based on Three Cases. Brit J Psychiatry. 1968;114 (506), 69-75.
12. Darien IL. The diagnostic criteria of the American Academy of Sleep Medicine. The international classification of sleep disorders. 3rd ed. Darien, IL: American Academy of Sleep Medicine; 2014.
13. Wilder J. A case of atypical Kleine–Levin syndrome: 30 years’ observation. J Nerv Ment Dis. 1972; 154 (1): 69–72.
14. Jeffries JJ, Lefebvre A. Depression and mania associated with Kleine-Levin-Critchley syndrome. Can Psychiatr Assoc J. 1973 ;18 (5):439-444.
15. Anderson G, Maes M. Melatonin: an overlooked factor in schizophrenia and in the inhibition of anti-psychotic side effects. Metab Brain Dis. 2012 ; 27 (2):113–119.
16. Monti JM, BaHammam AS, Pandi-Perumal SR, Bromundt V, Warren Spence D. Cardinali DP,et al. Sleep and circadian rhythm dysregulation in schizophrenia. Prog Neuro-Psychopharmacol Biol Psychiatry 2013; 43: 209-216.
17. Rodgers E, Marwaha S, Humpston C. Co-occurring psychotic and eating disorders in England: findings from the 2014 Adult Psychiatric Morbidity Survey. J Eat Disord . 2022 ; 10 (1) : 150 -159.
18. Groos E, Chaumereuil C, Flamand M, Brion A, Bourdin H, Slimani V, et al. Emerging psychiatric disorders in Kleine-Levin syndrome. J Sleep Res. 2018;27 (5) :e12690.
19. Gadoth N, Kesler A, Vainstein G, Peled R, Lavie P. Clinical and polysomnographic characteristics of 34 patients with Kleine–Levin syndrome. J Sleep Res 2001;10 (4):337–341.
20. Silva C, Cheniaux E, Telles-Correia D . Neuroimaging correlates of depression—Implications to clinical practice. Front Psychiatry 2019; 10:703.
21. Chen R, Cui Z, Capitão L, Wang G, Satterthwaite TD, Harmer C. Precision biomarkers for mood disorders based on brain imaging. BMJ. 2020 ; 9;371: 5.
22. Ortiz JF, Argudo JM, Yépez M, Moncayo JA, Tamton H, Aguirre AS, et al. Neuroimaging in the Rare Sleep Disorder of Kleine–Levin Syndrome: A Systematic Review. Clocks Sleep 2022, 4(2), 287–299.
23. Tiryaki A, Civil Arslan F, Yildirim M. Kleine-Levine Syndrome Co-occuring with Bipolar Disorder. Noro Psikiyatr Ars. 2017 ;54 (3):284-5.
24. Geoffroy PA, Arnulf I, Etain B, Henry C. Kleine-Levin syndrome and bipolar disorder: a differential diagnosis of recurrent and resistant depression. Bipolar Disord. 2013;15 (8) :899–9021.
25. Lachman A. Kleine-Levin syndrome as a neuropsychiatric presentation: A case report and review. S Afr J Psych. 2014; 20 (2):60-62.
26. Sachdev P. Is Kleine-Levin syndrome a variant of bipolar disorder? An hypothesis. Acta Neuropsychiatrica. 2008;20 (4):177-181.
27. Ambati A, Hillary R, Leu-Semenescu S, Ollila HM, Lin L, During EH, Farber N,et al. Kleine-Levin syndrome is associated with birth difficulties and genetic variants in the TRANK1 gene loci . Proc Natl Acad Sci USA.2021; 23;118(12):e2005753118.