Kleine-Levin syndrome is an exceptionally rare disorder characterized by recurrent episodes of hypersomnia associated with varying degrees of behavioral or cognitive disturbances and compulsive eating behavior. The disorder occurs predominantly in adolescent males with a benign clinical course and spontaneous remission as long as other neurological or psychiatric diseases are excluded. A viral or an autoimmune etiology has been suggested as up to 70% of patients have flu-like symptoms at the onset of their symptoms. In this report, we present a 9-year-old female patient with this rare disorder and review the relevant pediatric literature. She was previously healthy and presented with a 1-month history of generalized fatigue, excessive sleep and behavioral change. She would sleep for most of the day even while sitting and would resist being awakened. During brief periods of wakefulness, her mood will fluctuate from apathy to anger, sadness and aggression for minimal reasons. She would eat and drink excessively with a notable weight gain. Clinical examination and detailed investigations, including brain computerized tomography scan and electroencephalography were within normal limits. Remarkable improvement of her symptoms was noted after initiating methylphenidate and carbamazepine. We conclude that Kleine-Levin syndrome is an interesting rare disorder that needs to be diagnosed after excluding other causes of excessive sleep. Early recognition would result in appropriate treatment and shortened period of hospitalization.

Levetiracetam (LEV) is a new antiepileptic drug (AED), which has a mechanism of action distinct from that of other AEDs suggesting a potentially valuable therapeutic profile. Our objective is to report our experience in treating children with intractable epilepsy. Prospective, open label, add on trial of LEV in treating consecutive children with intractable epilepsy (defined as recurrent seizures after at least three antiepileptic medication trials). Follow up by one pediatric neurologist was performed. Therapeutic response was recorded as complete (no seizures), good (> 50% seizure reduction), fair (< 50% seizure reduction), or none. Thirty children (58% males) aged 15 months-15 years (mean 5.8 years, SD 3.9) were included. Most children (80%) had daily seizures, were tried on multiple AEDs (mean 4.7, SD 1.5), and had cognitive deficits (86%). The epilepsy was symptomatic in 64%. The mean LEV dose was 41 mg/kg/day and the children were followed for 4-8 months (median 5 months, SD 2.5). After the introduction of LEV, six (20%) children became completely seizure free and 43% had > 50% seizure reduction. The percentage of children with daily seizure was reduced from 80% before LEV to 27% afterward (P < 0.0001). Side effects were reported in 10 (33%) children in the form of decreased appetite, irritability, sedation, and seizure worsening. The majority were transient, however, LEV had to be withdrawn in four (13%) children because of lack of efficacy or seizure worsening. LEV is a novel AED with a broad spectrum of antiepileptic efficacy. The drug was well tolerated and most side effects were transient. However, larger controlled studies are needed in young children to establish the long-term efficacy and safety.