(It is important to state here that Ms A, along with others who had similar toxic exposures in Saudi Arabia, are currently involved in ongoing research to determine the presence and extent of effects or complications from any of these exposures.) The episodes of hypersomnolence have negatively affected her life, as she has been unable to predict or control their recurrence or duration. She attributes major stress as a significant contributing factor to the onset of her periodic hypersomnia given the documented nerve gas exposure and chemical warfare she was exposed to during Desert Storm while in Saudi Arabia.
The patient recalls having her first sleep attack 16 years previously in Saudi Arabia where she served voluntarily as a cook in the US Army for 4 months. Although she had previously started a sleep log, she reported never completing it but stated that her normal sleep pattern between episodes had been about 5 hours nightly. Ms A is a 44-year-old married white woman with a previous history of difficulty initiating sleep, which gradually disappeared but still left her with symptoms of excessive sleepiness associated with sudden “sleep attacks” lasting 2-3 days at a stretch and occurring 1 to 2 times a month. 3Īssociated precipitating factors of KLS include infection, alcohol ingestion, sleep deprivation, severe stress, traveling, surgery, head trauma, illicit drug use, and physical overexertion. 3, 4 This disorder is believed to be sporadic, although there have been some reports on familial cases, including monozygotic twins who both had KLS. 3, 4 It is more common among Ashkenazi Jews compared to the general population. KLS has an estimated prevalence of 1 to 5 cases per million people. Treatment is primarily symptomatic, depending on the severity of the disorder and on any comorbidity affecting the patient. The variability of symptoms often contributes to the difficulty in diagnosing, treating, and ameliorating symptoms of the disorder. The presentation, duration, course, and frequency of the disorder are quite variable among KLS patients. 2 Neuroimaging, physical examination, and laboratory testing results are often unremarkable in these patients. The etiology of KLS is unknown, but it is believed to be a result of an underlying hypothalamic dysfunction or a postinfectious autoimmune disorder. 1 Sleep and waking function between attacks is normal, with highly variable disease-free intervals. To the Editor: Kleine-Levin syndrome (KLS) is a rare, chronic, relapsing sleep disorder usually affecting adolescent males and characterized by paroxysmal sleep attacks with prolonged hypersomnia and with variable associated waking symptoms of hyperphagia, hypersexuality, and peculiar altered mental status function.
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