Onset of Kleine-Levin Syndrome in association with isotretinoin treatment

Child and Adolescent Psychiatric Unit, Department of Neuroscience, Uppsala University Hospital, Uppsala, Sweden.
Acta Paediatrica (Impact Factor: 1.67). 02/2010; 99(6):946-8. DOI: 10.1111/j.1651-2227.2010.01711.x
Source: PubMed


The synthetic retinoid isotretinoin is an effective treatment option for severe forms of acne vulgaris. However, several reports indicate that some patients experience altered central nervous system functions in association with treatment. We present here the first description of the onset of Kleine-Levin Syndrome (KLS), a rare disorder characterised by periodic hypersomnia and cognitive and behavioural symptoms, in close temporal relation to the start of isotretinoin treatment. We also discuss the biological potential of retinoids to affect sleep.
Conclusions: In light of a documented potential of retinoids to modulate sleep-wake regulation, the present case suggests that isotretinoin may rarely trigger the onset of KLS.

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    ABSTRACT:   There are a few case reports in literature that isotretinoin treatment may alter sleep architecture. Also studies in mice suggest a role of retinoids in the contribution of delta oscillations to the sleep electroencephalography.   The aim of this study was to investigate the effect of isotretinoin treatment on sleep architecture using polysomnography (PSG).   Twelve severe acne vulgaris patients without any psychiatric and sleep disorders were treated with 0.5 mg/kg of isotretinoin. Clinician-administered acne questionnaire, psychiatric examination, Epworth sleepiness scale and PSG recordings were performed after the first month of treatment.   Sleep efficiency was increased from 83.5% (62.8-89.0%, quartiles) to 89.5% (81.5-93.5%, quartiles; P = 0.036) and sleep latency decreased from 18.0 min (11.1-36.3, quartiles) to 15.5 min (9.3-19.0, quartiles; P = 0.023) following 1-month isotretinoin treatment. There were no significant changes in other sleep parameters of PSG and scores of Epworth sleepiness scale.   This study suggests that isotretinoin treatment slightly improves night-time sleep without any effects on sleep stages and daytime sleepiness.
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    ABSTRACT: Isotretinoin has revolutionized the field of dermatology, offering a cure for severe acne vulgaris and a therapeutic option for a variety of other chronic diseases and cancers. This drug has done more for many diseases in medicine than many drug classes have done for a single disorder, and yet, its use and availability have been threatened in the United States. Federal restrictions in the form of the IPLEDGE teratogenicity prevention plan have made the use of this drug more complex. Millions of dollars in litigation and claims of injury have fueled hysteria among laymen about the use of this drug. Overwhelmed with worries of its potential adverse effects, the public forgets that withholding isotretinoin therapy is not without its own risks. Isoteretinoin therapy can prevent lifelong and permanent physical and psychological scarring that comes as a matter of course with severe acne. Over 20 million people worldwide have taken the drug, with several studies demonstrating its safety and few long term adverse effects. This wonder drug's continued availability depends upon its responsible and informed use. This paper will review and put in perspective the issues important to consider in the proper use of isotretinoin.
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