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Clinical Research Case Report

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Dr. Saurabh Kumar

MBBS, M.D. (Psychiatry) 15 years experience overall Psychiatrist , Neuropsychiatrist , Sexologist

Atypical Kleine–Levin syndrome An elusive entity?

Published In: Journal of Family Medicine and Primary Care

About Journal of Family Medicine and Primary Care: The Journal of Family Medicine and Primary Care is a peer-reviewed medical journal that publishes research and case studies relevant to family medicine and primary healthcare. It serves as an invaluable resource for general practitioners, family physicians, and other healthcare professionals, offering up-to-date research, clinical insights, and guidelines to improve patient care at the primary level. The journal emphasizes a holistic approach to healthcare, with a focus on early diagnosis, prevention, and comprehensive management.


Abstract

Co-authored by Dr. Saurabh Kumar, this article titled "Atypical Kleine-Levin Syndrome: An Elusive Entity," published in the Journal of Family Medicine and Primary Care, presents a rare and insightful case study of an atypical presentation of Kleine-Levin Syndrome (KLS). The case highlights the complexities of diagnosing this rare sleep disorder, particularly when it deviates from its classical symptomatology. The report emphasizes the importance of considering atypical features in making an accurate and timely diagnosis, especially in primary care settings, where early identification can greatly influence patient outcomes.


Key Findings of the Research:


Atypical Presentation of KLS: The article documents the case of an 18-year-old male who presented with recurrent episodes of hypersomnolence and derealization over a period of five years. However, unlike the typical presentation of KLS, which is characterized by hypersomnia, hyperphagia, and hypersexuality, this patient exhibited none of the latter two symptoms. Instead, he experienced loss of appetite and decreased sexual interest—features opposite to the classical triad of KLS symptoms.
Diagnostic Challenges: The patient was initially misdiagnosed with unspecified nonorganic psychosis due to the presence of persecutory delusions and disorganized behavior during his first episode. Despite receiving multiple antipsychotics, the episodic hypersomnolence persisted, prompting a more detailed evaluation. This case underscores the diagnostic challenges posed by atypical KLS, especially when it mimics psychiatric disorders such as psychosis.
Clinical Investigations and Findings: The patient underwent extensive neurological and sleep-related investigations, including electroencephalography, magnetic resonance imaging (MRI) of the brain, and polysomnography, all of which returned normal results. A single-photon emission computed tomography (SPECT) brain perfusion study, however, revealed hypoperfusion in regions of the brain typically associated with KLS. These findings, in conjunction with the patient's clinical history, led to the diagnosis of atypical KLS.
Atypical Features in KLS: The case presented in this article adds to the growing body of evidence that atypical features, such as loss of appetite and decreased sexual interest, are more common in KLS than previously recognized. Studies cited in the article suggest that up to one-third of KLS patients may exhibit such atypical symptoms, which can lead to delays in diagnosis and inappropriate treatment.
Importance of Awareness Among Clinicians: The authors stress the need for greater awareness among primary care physicians, psychiatrists, and neurologists regarding the diverse presentations of KLS. Early recognition of atypical KLS is crucial for ensuring appropriate management and avoiding unnecessary psychiatric treatments. The case also highlights the importance of detailed sleep assessments in patients presenting with episodic hypersomnolence.


Applicability to the General Population:


The findings of this case report have significant implications for both clinical practice and the broader population. For healthcare providers, particularly those in primary care, the study emphasizes the importance of considering sleep disorders like KLS in patients presenting with unexplained hypersomnolence and atypical psychiatric symptoms. Misdiagnosis, as seen in this case, can lead to inappropriate treatments that may exacerbate the patient's condition.


For the general population, this research highlights the importance of understanding that not all psychiatric or neurological symptoms fit neatly into predefined categories. Atypical presentations, such as those seen in KLS, require careful clinical evaluation and may benefit from a multidisciplinary approach. Public awareness of rare sleep disorders could lead to earlier diagnosis and more effective management of such conditions, improving patient outcomes and quality of life.


In conclusion, "Atypical Kleine-Levin Syndrome: An Elusive Entity" contributes valuable insights into the complexities of diagnosing and managing KLS, particularly in cases that do not conform to its classical presentation. By raising awareness of atypical symptoms, the article encourages clinicians to adopt a more nuanced approach to diagnosing rare sleep disorders, ultimately leading to better patient care.


Author Information: Singh, Swarndeep, Saurabh Kumar, Rohit Verma, and Nand Kumar. "Atypical Kleine–Levin syndrome: An elusive entity?." Journal of Family Medicine and Primary Care 6, no. 1 (2017): 161-163.

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