Further experience using clarithromycin in patients with Kleine-Levin syndrome.

LE TT E R T O T H E E D IT O R W read with interest Drs. Rezvanian and Watson’s report of Kleine-Levin Syndrome (KLS) treatment with clarithromycin.1 We appreciate their expansion upon our work using GABA-A receptor antagonists, including fl umazenil and clarithromycin, for hypersomnia disorders.2-4 Our experience treating four KLS patients with clarithromycin follows. In patient 1, clarithromycin 500 mg bid was added to chronic bupropion at spell onset. His next three episodes were truncated. After stopping clarithromycin, he experienced 3 typical episodes. Resuming clarithromycin at his next spell again decreased symptoms, and he remains on intermittent clarithromycin. Patient 2 was treated unsuccessfully with oxcarbazepine, amphetamine/dextroamphetamine, modafi nil, and theophylline. Clarithromycin 250 mg bid during a spell resulted in immediate improvement, which was sustained over one week. One week after then discontinuing clarithromycin, KLS symptoms returned. Patient 3 experienced 3 KLS episodes/ year despite modafi nil, amantadine, and bromocriptine. Clarithromycin was titrated to 500 mg tid for daily use. His only KLS episode during the next 10 months coincided with discontinuation of clarithromycin. However, he then developed a KLS episode while taking clarithromycin and decided to discontinue treatment, citing side effects. Patient 4 experienced mild improvement from modafi nil during an episode, while clarithromycin resulted in marked improvement. Despite accompanying nausea, she plans to take clarithromycin (500 mg bid) with subsequent episodes. All four KLS patients responded at least partially to clarithromycin, and benefi t was sometimes sustained. Thus, in some KLS patients there might be a role for clarithromycin use, although optimal timing of treatment (e.g., chronic or only during a spell) remains to Further Experience using Clarithromycin in Patients with Kleine-Levin Syndrome Comment on Rezvanian and Watson. Kleine-Levin syndrome treated with clarithromycin. J Clin Sleep Med 2013;9:1211-2.