Sleeping beauty syndrome presenting with insomnia

Area of Science:

• Neurology
• Psychiatry

Background:

• Kleine-Levin syndrome (KLS) is a rare neurological disorder characterized by recurrent episodes of hypersomnia and cognitive, behavioral, and mood disturbances.
• Psychotic symptoms are not typically considered a core feature of KLS, but their occurrence can complicate diagnosis and management.

Observation:

• A young male patient with a known diagnosis of KLS presented with an 8-day history of behavioral abnormalities.
• Symptoms included decreased sleep and appetite, hypersexuality, aggression, and visual hallucinations.
• Initial investigations in the emergency department were unremarkable.

Findings:

• A preliminary diagnosis of a KLS episode with superimposed psychosis was established.
• The patient was treated with aripiprazole (10 mg daily) and intravenous lorazepam for agitation/insomnia.
• Upon discharge, the patient had returned to his baseline functioning.

Implications:

• This case suggests that KLS episodes can present with psychotic features, necessitating a tailored treatment approach.
• Pharmacological management involving atypical antipsychotics and mood stabilizers (e.g., lithium) may be effective in resolving acute psychotic symptoms during KLS episodes.
• Further research into the neurobiological underpinnings of psychosis in KLS is warranted.