Treatment of Kleine-Levin Syndrome with Aripiprazole.

[Author Affiliation]Savas Yilmaz. Department of Child and Adolescent Psychiatry, Necmettin Erbakan University Meram Medical School, Konya, Turkey.Omer Faruk Akca. Department of Child and Adolescent Psychiatry, Necmettin Erbakan University Meram Medical School, Konya, Turkey.Ayhan Bilgic. Department of Child and Adolescent Psychiatry, Necmettin Erbakan University Meram Medical School, Konya, Turkey.Address correspondence to: Savas Yilmaz, N.E.U. Meram Tip Fakultesi Cocuk Psikiyatrisi AD, Meram Konya 42100, Turkey, E-mail: drsavash@gmail.comTo The Editor:Kleine-Levin syndrome (KLS) is a rare and disabling disorder characterized by recurrent episodes of hypersomnia as well as cognitive and behavioral abnormalities such as compulsive hyperphagia and hypersexual behavior. These episodes usually last a few days to weeks; however, the recurring nature of the syndrome can disrupt the individual's social, professional, and family life. Furthermore, irritability/hostility, social disinhibition, obscene language, depersonalization/derealization, and depressive and/or manic symptoms can co-occur during the episodes (Arnulf et al. 2005). Although the etiology of KLS is not well known, various drugs, including stimulants, lithium, antiepileptics, antipsychotics, and antidepressants have been used in the treatment of the disorder (Oliveira et al. 2013). However, there have been no reports on the effectiveness of aripiprazole on KLS. Herein, we present an adolescent with KLS who displayed complete remission after aripiprazole therapy.Case ReportThe patient was a 15-year-old girl who had experienced four recurrent episodes -lasting for ∼ 10 days - of severe sleepiness within a 4 month span. During these episodes, she was sleeping most of the day. She could be awakened, but was confused and was unable to maintain concentration or recall recent events during the awakened times of the sleep episodes. Her family described her awake times as "like in a dream. " After the sleepy period, she had an overactive, less sleeping, and anxious period in which she showed erotomanic and referential preoccupations, derealization, compulsive behaviors (i.e., frequent hand washing), and hyperphagia. This episode ended after 7 days and was followed by an asymptomatic period lasting 1 week. Thereafter, another sleepy episode began, and episode durations were similar for all four episodes. During the asymptomatic phase, the patient described partial amnesia for the events that had occurred. She denied any hypersexual behavior during or after the episodes. She had been admitted to a child psychiatry clinic with these complaints and was administered sertraline (25 mg), haloperidol (1 mg), and imipramine at different times. However, no improvement was observed with these medications. She was seen by a neurologist who observed no epileptic activity or neurological pathology. She had normal electroencephalogram (EEG) and brain magnetic resonance imaging (MRI) reports. To support the KLS diagnosis, human leukocyte antigen (HLA) analyses (DQB1) were studied in a genetic laboratory, based on the literature indicating that this antigen group may be related to KLS (Huang et al. 2012). The DQB1*06 and DQB1*03 antigens were found to be positive.We had diagnosed this patient as having KLS based on the clinical findings and HLA analyses results, according to the International Classification of Sleep Disorders-II (American Academy of Sleep Medicine 2005). The patient's medications were terminated upon admission, and aripiprazole (5 mg/day) was started to target the erotomanic and referential preoccupations during the overactive period. After admission, the overactive period ended after 1 week, and a sleepy episode did not recur. During the patient's follow-up examination after 2 years of aripiprazole treatment, the sleepy and overactive periods had not recurred, and all symptoms had disappeared except for minimal referential thoughts, which were not affecting her functionality. …