Lithium therapy in Kleine-Levin syndrome: An open-label, controlled study in 130 patients.

Abstract

OBJECTIVE:

To compare the benefits and risks of lithium therapy vs abstention/other treatments in Kleine-Levin syndrome (KLS).

METHODS:

In a KLS cohort followed in a single center, 130 patients regularly took lithium carbonate (median dose 1,000 mg/day; n = 71; 40 children), valproate (n = 5), contraceptive pill (n = 5), or no treatment (n = 49). The disease characteristics (frequency, mean, and longest durations of episodes, time incapacitated per year) were compared before and after follow-up in the lithium vs abstention groups.

RESULTS:

The time between KLS onset and therapeutic onset was 69 ± 92 months. The patients were then followed up for a mean of 21.5 ± 17.8 months. Before treatment, the 71 patients treated with lithium tended to have a higher frequency of episodes per year (3.8 ± 2.9 vs 2.9 ± 2.6) and had a longer time spent incapacitated (57 ± 51 vs 37 ± 35 days) than the untreated patients. The mean (-8 ± 20 vs 2 ± 13 days) and longest (-18 ± 35 vs -5 ± 13) episode duration, the time spent incapacitated (-37 ± 65 days vs -10 ± 38), as well as the frequency of episodes per year (-2.6 ± 2.9 vs 1.3 ± 2.78) decreased significantly more in the treated than in the untreated patients. Side effects (reported by 50% of the patients) were mild and classical with lithium (tremor, increased drinking, diarrhea, and subclinical hypothyroidism).

CONCLUSIONS:

In this large, prospective, open-label, controlled study, the benefit/risk ratio of lithium therapy is superior to that of abstention, supporting the concept that lithium has anti-inflammatory/neuroprotective effects.

CLASSIFICATION OF EVIDENCE:

This study provides Class IV evidence that for patients with KLS, lithium decreases the frequency and duration of KLS episodes.

• Authors: Smaranda Leu-Semenescu, Thibault Le Corvec, Elisabeth Groos, Sophie Lavault, Jean-Louis Golmard, Isabelle Arnulf
• Journal: Neurology (Neurology) Vol. 85 Issue 19 Pg. 1655-62 (Nov 10 2015) ISSN: 1526-632X [Electronic] United States
• PMID: 26453648 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © 2015 American Academy of Neurology.

Chemical References

• Lithium Carbonate

Topics

• Adolescent
• Adult
• Child
• Cohort Studies
• Female
• Follow-Up Studies
• Humans
• Kleine-Levin Syndrome (diagnosis, drug therapy, psychology)
• Lithium Carbonate (therapeutic use)
• Male
• Prospective Studies
• Young Adult