We all know the fairy tale of Sleeping Beauty. The story is about a little princess from a distant kingdom, named Aurora. The same day that the girl comes into the world, she is bewitched with a terrible curse by an evil fairy, in revenge for not having been invited to the celebration of her birth. The spell was that on the day the princess reached the age of fifteen, she would prick her finger with the needle of a spinning wheel and die. A kind fairy, present at the treat, transforms the cruel spell with her powers and, instead of dying, the adolescent will remain asleep for a hundred years until a prince charming comes to save her in his castle and wakes her up with a kiss..
In the case that concerns us here, the patient who suffers from this syndrome does not prick himself with a spinning wheel and there are no fairies or handsome princes saviors. The simile with this fantastic story is that someone who suffers from Kleine-Levin suffers prolonged periods of night sleep, hence this group of symptoms is also known in literature as the Sleeping Beauty syndrome..
As we have already advanced in the introduction to this article, the most significant manifestation of this clinical picture is that hypersomnia, which presents with a relapsing course. Symptoms usually appear abruptly for the first time and appear periodically for several days or even weeks, with the usual presence of various symptomatic periods several times a year. On other occasions, the affected person can spend long stages of months or years completely free of any vestige of the disease until the appearance of a new crisis.
When this clinical picture is manifested, the patient can sleep between approximately 18 and 20 hours, followed by periods of "lucidity" lasting a few hours in which the person is only able to perform basic functions such as eating or going to the bathroom. . During this period of time, they tend to suffer disorientation, irritation and confusion, which is why they are unable to carry out socio-occupational activities normally, such as studying or going to work. After this brief interval of "lucidity", the subject re-enters a long period of sleep..
Accompanying this hypersomnia, there are also signs of behavioral disinhibition; such as indiscriminate hypersexuality, hyperphagia (excessive and compulsive eating, sometimes through bingeing) with the consequent weight gain, irritability that can lead to hostile and aggressive behaviors, and other symptoms such as emotional instability, thinking difficulties, spatio-temporal disorientation , amnesia, and even manifestations of the psychotic spectrum such as hallucinations.
Once the seizures are over, both behavior and mental functions return to normal. It is quite common that, after the episode, the patient has amnesia and does not remember anything of what happened.
The subject can present long periods; weeks, months, or even years, completely symptom-free. When you are in this asymptomatic period, you can live a completely normal life and do not suffer from any sleep disorder, or any other physical or personality disorder.
The syndrome usually occurs mainly in adolescents and is three times more common in men than in women. The condition usually begins in adolescence and usually disappears, in most cases, spontaneously at the age of 30 or 40..
The study of the symptoms of this syndrome has made it possible to relate this pathology with the limbic system, for the entire emotional and disinhibitory component of the disorder, and more specifically with hypothalamic dysfunctions, since this brain area is one of the main ones in charge of basic functions such as sleep and appetite. Other hypotheses point to a dysregulation in the metabolism of neurotransmitters such as serotonin or autoimmune phenomena.
Although the exact etiology of the disease is still unknown, in some cases, it has been observed that it has been preceded by fever, tension, or excessive exposure to sunlight..
To this day, there is no treatment that cures this disease. From the field of psychiatry, the prescription of psychostimulant drugs such as amphetamines, methylphenidate and modafinil is usually recommended with the intention of reducing the intensity and duration of hypersomnia episodes. Although as we have commented, due to their unpredictability, they cannot be avoided.
It is worth noting that, in some controlled studies, a significant number of patients have responded to lithium salts satisfactorily..
Psychological support, added to the pharmacological treatment in an adjuvant way, is convenient in order to provide the patient with a space where they can learn about the specific characteristics of their pathology and where they can also develop strategies for the management of secondary symptoms associated with the syndrome..
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