Background: Kleine – Levin syndrome (KLS), also called “Sleeping beauty syndrome” is a rare sleep disorder characterized by recurrent episodes of hypersomnia, hyperphagia, cognitive disturbances, and hypersexuality.The underlying pathophysiology remains unknown.Kleine-Levin syndrome is often misdiagnosed as depression, bipolar disorder, psychosis, seizures, or intoxication. The disorder is at the interface of neurology and psychiatry. Attacks decrease in frequency and eventually cease in most cases of adolescent onset.
Case presentation: we are reporting the first case of KLS from Saudi Arabia, a 14-year-old boy, with delay in diagnosing KLS. His history started 2 years prior to presentation with fever which was treated imperially, after that started to have excessive sleepiness up to 20 hours per day, with difficulty to awake him from sleeping.The patient was admitted 2 times to other hospital and was diagnosed and treated as epilepsy.His sleep study and multiple sleep latencies test (MSLT) reported severely reduced sleep latency confirming pathogenic sleepiness. The diagnosis of KLS was made as per diagnostic criteria of International Classification of Sleep Disorders after ruling out other possible causes of hypersomnia. The patient responded well to treatment with modafinil and other anti-psychosis medications.
Conclusion: KLS is a rare sleep disorder with a lot of psychiatric symptoms that can be wrongly diagnosed as neurological or psychiatric illness, hence, it is important for clinicians to have high index of suspicion on such atypical presentations.
There is no definitive treatment for KLS, however some cases showed clinical improvement with some medications. The prognosis of KLS is considered to be good with spontaneous remission in most of the cases in later years.
Potential research directions are to explore infectious, autoimmune, metabolic and genetic causes.
Kleine – Levin,children, Saudi Arabia, case report