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A case of Kleine–Levin syndrome arising during chemotherapy: efficacy of oral L-carnitine

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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.

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Authors and Affiliations

  1. Agency for Student Support and Disability Resources, Kyoto University, Kyoto, Japan

    Ryuji Furihata

  2. Shinjuku Sleep and Respiratory Clinic, KEISHINKINENKAI Medical Corporation, Shinjuku-I-Land Tower 12F, 6-5-1 Nishishinjuku, Shinjuku-Ku, Tokyo, 163-1312, Japan

    Daisuke Endo, Kenichi Nagaoka, Ayako Hori, Tatsuya Ito & Toshiki Akahoshi

  3. Division of Respiratory Medicine, Department of Internal Medicine, Nihon University, Tokyo, Japan

    Kenichi Nagaoka & Toshiki Akahoshi

  4. Division of Sleep Medicine, Department of Sleep Medicine and Respiratory Care, Nihon University, Tokyo, Japan

    Kazuo Chin

  5. Department of Human Disease Genomics, Center for Genomic Medicine, Graduate School Medicine, Kyoto University, Kyoto, Japan

    Kazuo Chin

Authors
  1. Ryuji Furihata
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  2. Daisuke Endo
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  3. Kenichi Nagaoka
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  4. Ayako Hori
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  5. Tatsuya Ito
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  6. Kazuo Chin
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  7. Toshiki Akahoshi
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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

Correspondence to Toshiki Akahoshi.

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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.

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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

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  • DOI: https://doi.org/10.1007/s41105-022-00434-0

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