Dados do Trabalho

Título

"Kleine-Levin Syndrome: Favorable Response to Treatment with Escitalopram and Trazodone in Reducing Hypersomnia – Case Report"

Introdução

Kleine-Levin syndrome (KLS) is a rare disorder characterized by abrupt and recurrent episodes of hypersomnia, associated with cognitive and psychiatric dysfunction. In addition to hypersomnia, disinhibited sexual behavior and eating disorders may occur. Studies show that although the classic triad of hypersomnia, hyperphagia, and hypersexuality is rare, the tetralogy of hypersomnia, confusion, apathy, and derealization is prevalent. Infections and sleep deprivation have been identified as triggers.

Objetivo

To illustrate the importance of an accurate diagnostic approach and individualized treatment to optimize clinical outcomes in the management of KLS.

Métodos

A 15-year-old male patient presented with excessive sleepiness for 30 days after a bacterial infection treated with antibiotics. The clinical picture was marked by episodes of derealization, neglect of personal hygiene and hypersexuality. Upon awakening, he showed irritability, apathy and sluggishness. The episodes of sleepiness were interspersed with asymptomatic periods. Neurological examinations, cranial magnetic resonance imaging and cerebrospinal fluid analysis revealed no abnormalities. However, subsequent hematological alterations led to the diagnosis of Chronic Myeloid Leukemia. Initial treatment with Interferon and, later, with Imatinib, did not result in improvement of hypersomnia.
Given the persistence of symptoms, a neurological reassessment with polysomnography was performed, which revealed low sleep efficiency, an increase in stages 1 and 2 of NREM sleep and a reduction in REM sleep. Given these findings, treatment with Escitalopram and Trazodone was initiated, resulting in a significant reduction in episodes of hypersomnia and an improvement in quality of life.

Resultados

Diagnosing KLS can be challenging because of its similarity to psychiatric disorders and other hypersomnias. KLS is distinguished by acute, intense episodes of hypersomnia with rapid resolution of affective symptoms, distinguishing it from atypical depression and narcolepsy. Treatment for KLS may include modafinil, methylphenidate, lithium, and antidepressants to prevent recurrence and moderate mood changes.

Conclusões

KLS is a complex disorder with episodes of severe hypersomnia and behavioral dysfunctions. Treatment with Escitalopram and Trazodone was effective in reducing episodes and improving quality of life, highlighting the importance of continuous and personalized assessment in the management of KLS.

Palavras -chave

Hypersomnia, derealization, Kleine-Levin syndrome.