Abstract
A woman in her 50 s with Kleine–Levin syndrome (KLS) was referred to our sleep clinic for recurrent episodes of sleep hypersomnia lasting for two to 3 days, despite attempts to remain awake. These episodes were unaccompanied by anxiety or depression, increased appetite, increased sex drive, irritability, or hallucinations, and had first appeared during chemotherapy for malignant lymphoma. Video polysomnography revealed mild obstructive sleep apnea syndrome (apnea–hypopnea index 7.9/h), but no other abnormalities. All blood tests and brain imaging investigations, including brain MRI and A 123I-ioflupane SPECT, yielded normal results. Oral L-carnitine was found to be effective for shortening the period of hypersomnolence, reducing the degree of hypersomnolence, and prolonging the inter-episode period. Since it has been reported that alkylating agents may induce carnitine deficiency, the present observations appear to support the involvement of carnitine in the onset of KLS.
Similar content being viewed by others
Data availability statement
The participant has consented to the submission of the case report to the journal.
References
Arnulf I, Rico TJ, Mignot E. Diagnosis, disease course, and management of patients with Kleine-Levin syndrome. Lancet Neurol. 2012;11(10):918–28.
Longo N, Frigeni M, Pasquali M. Carnitine transport and fatty acid oxidation. Biochim Biophys Acta. 2016;1863(10):2422–35.
Romigi A, Liguori C, Izzi F, Albanese M, Marchi A, Mancini C, Tarquini E, Mercuri NB, Placidi F. Oral L-carnitine as treatment for narcolepsy without cataplexy during pregnancy: a case report. J Neurol Sci. 2015;348(1–2):282–3.
Barros F, Aguilar ACR, Tufik S, Coelho FM. Oral L-Carnitine used to treat narcoleptic type 1 patient during pregnancy—A case report. Sleep Sci. 2018;11(4):215–6.
Miyagawa T, Kawamura H, Obuchi M, Ikesaki A, Ozaki A, Tokunaga K, Inoue Y, Honda M. Effects of oral L-carnitine administration in narcolepsy patients: a randomized, double-blind, cross-over and placebo-controlled trial. PLoS ONE. 2013;8(1):e53707.
Erdem M, Bolu A, Garip B, Karaman D, Yetkin S. Clinical and polysomnographic features of kleine-levin syndrome: case series. Noro Psikiyatr Ars. 2013;50(3):288–90.
Medicine AAoS. 2014 International Classification of Sleep Disorders. American Academy of Sleep Medicine.
Badino R, Caja A, Del Conte I, Guida C, Ivaldi M. Kleine-Levin syndrome in an 82 year old man. Ital J Neurol Sci. 1992;13(4):355–6.
Sayed-Ahmed MM. Role of carnitine in cancer chemotherapy-induced multiple organ toxicity. Saudi Pharm J. 2010;18(4):195–206.
Funding
NO.
Author information
Authors and Affiliations
Contributions
RF: wrote the manuscript in concertation with DE, KN, AH, TI, CK, and TA. All authors contributed to the article and approved the submitted version.
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The Department of Sleep Medicine and Respiratory Care, Division of Respiratory Medicine, Nihon University of Medicine is funded by endowments from Philips Respironics, Fukuda Denshi, Fukuda Lifetec-Tokyo, and Resmed to Nihon University.
Ethics statement
The patients/participants provided their written informed consent to participate in this study.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Furihata, R., Endo, D., Nagaoka, K. et al. A case of Kleine–Levin syndrome arising during chemotherapy: efficacy of oral L-carnitine. Sleep Biol. Rhythms 21, 257–260 (2023). https://doi.org/10.1007/s41105-022-00434-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s41105-022-00434-0