Kleine-Levin Syndrome managed with Carbamazepine

A report describes a case of a three-year-old boy who presented with 36–72-hour attacks of unresponsiveness with normal vital signs and without any specific neurological symptoms. Lab investigation of Cerebrospinal fluid (CSF), metabolic screening, anti-GAD antibodies, and thyroid returned normal. However, he displayed elevated ALT and AST values and positivity for cytomegalovirus IgM and PCR. Furthermore, he had a normal EEG and brain MRI. The patient recovered in 10 days. 

In the next seven months, the patient had two more similar episodes, which directed the administration of intravenous immunoglobulin and steroid treatments. 

During his fourth attack in the clinic, the EEG showed non-REM 1–2 sleep without any encephalopathic findings. The patient also displayed food aversions and crying attacks. Video polysomnography-electroencephalography (PSG-EEG) monitoring revealed very short sleep latency (150 s), consisting of 73% non-REM-2, 16% non-REM-3, and 1.3% REM episodes. These findings indicated the diagnosis of Kleine-Levin syndrome (KLS). 

The patient received Carbamazepine therapy and remained attack-free for four years. 

Ulgen Temel E, Serdaroglu E, Koc Ucar H. et al. Response to Carbamazepine in a Case of Kleine-Levin Syndrome. Indian J Pediatr. 2024. https://doi.org/10.1007/s12098-024-05132-y