Refractory Insomnia in an Adolescent with Total Blindness

Area of Science:

• Neurology
• Sleep Medicine
• Ophthalmology

Background:

• Non-24-hour sleep-wake disorder (N24) is a circadian rhythm disorder common in totally blind individuals.
• Refractory insomnia in adolescents presents significant challenges, often stemming from multiple underlying conditions.
• Restless legs syndrome (RLS) can exacerbate sleep disturbances and impact quality of life.

Observation:

• A totally blind adolescent presented with persistent, treatment-resistant insomnia.
• The patient exhibited symptoms consistent with both Non-24-hour sleep-wake disorder and restless leg syndrome.
• Previous insomnia treatments had proven ineffective.

Findings:

• Successful management of refractory insomnia was achieved using a combination therapy.
• Tasimelteon, a melatonin receptor agonist, was administered for Non-24-hour sleep-wake disorder, marking its first reported use in an adolescent for this condition.
• Iron replacement therapy addressed potential iron deficiency contributing to RLS, and gabapentin was used for symptom management.

Implications:

• This case demonstrates the efficacy of tasimelteon in treating adolescent Non-24-hour sleep-wake disorder.
• It underscores the critical need to identify and manage all contributing factors in complex pediatric insomnia cases.
• The findings suggest a potential therapeutic strategy for similar multifactorial sleep disorders in adolescents.