Case Presentation
An 18-year-old young man from Syria, one of seven children in his family, experienced a series of unusual and concerning health events. His mother reported that he had episodes where he slept for extended periods, sometimes up to nine days. During these episodes, he required significant assistance from his parents for basic daily functions, such as eating and using the bathroom. These episodes occurred four times within a year, often following periods of intense physical or emotional exertion.
Investigations
The young man had no prior history of mental health issues, such as depression or anxiety, or any history of seizures or excessive daytime sleepiness. However, he did experience noticeable side effects after these prolonged sleep episodes. These included significant weight gain and difficulty concentrating or thinking clearly.
To investigate the cause of these episodes, doctors conducted a series of medical tests. These included blood tests to check for underlying medical conditions, a brain scan (MRI) to rule out any structural abnormalities in the brain, and an EEG to monitor his brainwave activity. While the EEG showed some minor irregularities in brainwave patterns, there was no evidence of seizures or other significant neurological abnormalities.
Based on the patient’s symptoms and medical history, doctors initially suspected a rare condition called Kleine-Levin Syndrome (KLS). This is characterized by recurrent episodes of excessive sleep. However, a sleep study conducted to confirm this diagnosis did not support the initial suspicion.
Management of the Sleep Disorder
Treatment began with medications typically used to improve wakefulness, but these did not effectively address the patient’s condition. Subsequently, he was treated with an anti-seizure medication called levetiracetam. Over the course of six months, this medication proved successful in preventing further episodes.
Following the successful treatment period, the patient underwent follow-up tests, including another EEG and a repeat sleep study, both of which showed normal results. He continued to take levetiracetam as prescribed and experienced no further episodes or significant side effects from the medication. The patient remained under the care of a neurologist for regular checkups to monitor his condition and ensure ongoing well-being.
Discussion
Humans spend approximately one-third of their lives asleep, cycling through distinct stages of rapid eye movement (REM) and non-REM sleep. Sleep is crucial for physical and mental health, and disruptions to these natural sleep patterns can significantly impact overall well-being. Sleep disorders encompass a wide range of conditions, including insomnia (difficulty falling or staying asleep), sleep apnea (interruptions in breathing during sleep), and circadian rhythm disorders (misalignment of the body’s internal clock with the day-night cycle). These disorders can have a profound impact on daily life, affecting mood, energy levels, and cognitive function.
Sleep Disorder
Sleep disorders are a widespread health concern, encompassing a variety of conditions that disrupt normal sleep patterns. The International Classification of Sleep Disorders (ICSD) categorizes these disorders, including insomnia, sleep-disordered breathing (like sleep apnea), circadian rhythm sleep-wake disorders (misalignment of the body’s internal clock), parasomnias (such as sleepwalking and night terrors), sleep-related movement disorders, and central disorders of hypersomnolence. This case report focuses on a patient experiencing hypersomnolence, a condition characterized by excessive daytime sleepiness.
Idiopathic hypersomnia (IH) is a rare disorder characterized by excessive daytime sleepiness, even after adequate nighttime sleep. Individuals with IH often experience long, uncontrollable naps, difficulty waking up, and an overwhelming urge to sleep. While the exact cause of IH remains unclear, potential contributing factors may include changes in sleep habits, stress, or head injuries. However, in this specific case, several factors suggest that IH is unlikely. Firstly, the patient did not report frequent sleep attacks, a hallmark symptom of IH. Secondly, the patient’s Multiple Sleep Latency Test (MSLT) result did not meet the diagnostic criteria for IH.
Narcolepsy is another sleep disorder characterized by excessive daytime sleepiness, often accompanied by cataplexy, a sudden loss of muscle tone. Narcolepsy is further divided into two types: type 1, associated with a deficiency of hypocretin (a brain chemical), and type 2, which does not involve cataplexy. Diagnostic criteria for narcolepsy include frequent sleep attacks, short sleep latency on the MSLT, and the presence of sleep-onset REM periods. In this case, the patient did not meet all the diagnostic criteria for narcolepsy.
Kleine-Levin Syndrome (KLS)
Kleine-Levin Syndrome (KLS) is a rare condition that can be considered in cases of hypersomnia. It is characterized by recurrent episodes of prolonged sleep, often accompanied by other symptoms such as hypersexuality, compulsive eating, and behavioral disturbances. While the patient in this case exhibited some overlap with KLS, such as hypersomnia and increased appetite, other key symptoms of KLS, including memory deficits, behavioral disturbances, and hypersexuality, were absent.
Based on the patient’s clinical presentation, the results of investigations such as polysomnography and MSLT, and the absence of diagnostic criteria for IH, narcolepsy, and KLS, this case presents a unique diagnostic challenge. Furthermore, the patient’s successful treatment with levetiracetam is noteworthy. This is because studies have not consistently demonstrated significant effects of levetiracetam on sleep structure in general.
Conclusion: Sleep Disorder
This case presents a unique and intriguing sleep disorder. Unlike any previously reported cases, this patient’s symptoms did not align with the criteria for any known sleep disorder. Furthermore, the patient’s unexpected response to the medication levetiracetam is highly unusual. Since levetiracetam typically has no significant impact on sleep patterns, this case suggests a potential area for further research. Investigating the effects of levetiracetam on patients with hypersomnia and other sleep disorders may offer valuable insights into novel treatment approaches.
