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The teenager who sleeps for 10 days

By Frances Cronin BBC News

Trying to wake Louisa during one of her episodes is difficult

While most teenagers struggle to get out of bed in a morning, Louisa Ball might

take 10 days to fully wake from her slumber, due to a very rare neurological

disorder. So what's it like living with Kleine-Levin Syndrome?

Louisa has slept through holidays, friends' birthdays and half of her GCSEs.

In 2008, aged 14, she had been suffering from flu-like symptoms. She was at her

school in Sussex when she started nodding off in class and behaving strangely.

"I didn't know what I was doing, what I was saying, everyone thought 'hey this

isn't right,'" she recalls.

"I was hallucinating and after that I don't remember anything. All of a sudden

it just went blank and I just slept for 10 days. I woke up and I was fine

again."

Her parents Rick and Lottie watched their daughter becoming fidgety and with

unusual facial expressions as she sank into sleep. The first time was a

frightening experience for them, although Louisa herself says she wasn't scared

by the episode, more puzzled.

"It was really weird, no one knew what was wrong, we just thought it wasn't

going to happen again. And then four weeks later it happened again."

What is Kleine-Levin Syndrome?

KLS is a disease of adolescence, and sometimes will begin after infection or

illness, says Tom Rico of the Center for Narcolepsy & KLS Research at Stanford

University, California.

"An individual with KLS will have sleep episodes, typically lasting between one

and three weeks, with coinciding cognitive disturbance in the few hours of

wakefulness.

"During this time period, a patient will sleep anywhere between 16 to 22 hours

a day, every day, until the conclusion of the episode."

But the excessive sleeping is only half the problem, he says, because when

awake during the episode, patients experience what they describe as a

"dream-like state".

She was finally diagnosed with Kleine-Levin Syndrome (KLS). There is no known

cause or cure but Louisa says it was good to know what it was and that it

wasn't life threatening.

The average time it takes to diagnose the condition is four years, because

there is no test and so it requires a process of elimination of other

disorders.

The disease was named after Willi Kleine, a neurologist from Frankfurt, and Max

Levin, a psychiatrist from New York, who identified patients with similar

symptoms in 1925 and 1936.

Louisa is unusual as KLS usually affects teenage boys, who can also exhibit

hypersexuality and inappropriate behaviour.

As well as excessive sleeping, symptoms include behaviour changes,

irritability, feeling in a dream-like state and binge eating, symptoms that can

be mistaken for normal teenage behaviour. There are no drugs that have

conclusively shown to alleviate symptoms.

'No dreams'

Louisa Ball Louisa was relieved not to miss her school prom

People with the sleep disorder narcolepsy fall asleep immediately, but people

with KLS might sleep more and more over a number of days before falling into

sleep mode.

Louisa says she remembers very little when she wakes up from an episode: "It's

just blank - no dreams. Now I'll remember a lot more that's gone on. Before I

wouldn't remember anything at all. My dad thinks my brain is learning to cope

with it more."

So how do you deal with a disorder that takes over your life so much?

It nearly ruined Louisa's career ambitions, because she slept through most of

her GCSEs but her college allowed her to enrol and she is studying sport

performance and excellence, with dreams of being a dancer.

What happens after an episode?

"After these one to three weeks, the individual will experience a full recovery

from the symptoms upon conclusion of the episode," says Mr Rico.

"All of the symptoms go away completely, sleep habits return to normal, and

cognitive behaviour is no longer affected.

"Sometimes patients describe it like a light switch, where the symptoms will be

turned on or off almost immediately, with this dramatic transition over the

course of a few hours."

A recovered state can last between a month and a year, and symptoms last a

median of eight years, he says. The episodes become less frequent and less

severe, until they finally stop.

The recommended treatment is to allow the patient to sleep, rather than using

medication.

At first, her school teachers didn't understand, she says. "They'd give work to

my brother for me to do and when I went back to school they expected me to have

done it but I'd have slept for 10 days."

Some people with KLS have complained they have lost their friends because they

suddenly disappear for weeks on end but Louisa has a close knit group of

girlfriends. Some even visit her when she's sleeping, just to check she's ok.

When she wakes up, it takes her a few days to fully come round, and her body is

quite stiff so her dancing is affected for while.

"I've never really got upset about it but I sometimes do think 'why me',

because I've always been a normal healthy person. But all of a sudden it

happened and there's no reason why it happened and that sometimes frustrates

me.

"But I've got used to it now and learnt to live with it. I'm a special kid."

The change in behaviour before and during a sleep episode is one of the most

upsetting things for Louisa's parents, who take it in turns to remain with her.

Doctors have told the family it's crucial to wake Louisa once a day to feed her

and get her to the bathroom.

Rick and Lottie Ball Parents Rick and Lottie took Louisa to France to find out

more about the condition

But Lottie admits it can take a while to get her to come round. "I've tried

before to literally force her to wake up but she just starts swearing and gets

so agitated and aggressive."

After watching a video the family made of her while sleeping, Louisa says: "I

look scary, it doesn't look like me, it's like I'm on drugs."

Frustrated by the lack of information in the UK, Louisa was taken by her

parents to the Hospital Piti -Salp tri re in Paris, where researchers are

looking into whether it is caused by a defective gene.

Many sufferers have abnormalities in their temporal lobe, the area of the brain

involved in behaviour and memory. A scan of Louisa's brain function revealed

she does have abnormalities in her frontal lobe but there are no signs that

this has affected her behaviour or memory.

The good news is the disease can also disappear just as suddenly as it came on.

This normally happens after 10 to 15 years.

How rare is it?

It is too rare or too under-reported to give an accurate figure to illustrate

how rare it is, says Mr Rico. Because so many cases go undiagnosed or

unreported, it is impossible to estimate the prevalence, which is why you won't

find that number listed in any literature.

But Louisa is currently going through a good period. She was out doing

Christmas shopping with her best friend this week and has not had an episode in

13 weeks. A few weeks ago she won yet another dance competition.

"It's almost as if I've forgotten about it because I haven't had one in so

long."

Louisa's parents, however, are still watching her constantly for signs she

could be heading into a sleep state.

"It's weird - now I've left school I haven't actually had an episode, they

probably think I was faking it," she jokes.

Comments

All posts are pre-moderated

and must obey the house rules

5 Hours Ago

I suffer with KLS myself and the sleep is only part of it. To be honest, it's

the easiest part for me. It's the other symptoms that, by far, make my life

hell during episodes. I turn child-like, anxious, and have severe memory

problems. I cannot watch television, read, nor hold a conversation. I had a 1.5

year break and now they're not so severe but it stills puts everything in my

life on hold.

8th december 2010 - 23:09

Actually, narcoleptics don't "fall asleep right away". That can happen, but it

doesn't come close to explaining narcolepsy and sleep. Frequently there are

hallucinations--visual, auditory, and tactile--and falling asleep can take a

long time. (Narcolepsy is confusing, and the average time to diagnosis is 14

years.)

I can't imagine going through this as a teen. Louisa is handling it admirably.

8th december 2010 - 19:20

I have possible KLS combined with neurocardiogenic syncope. To those ignorant

enough to consider this a lifestyle choice of 'laziness' need to define a

distinct difference between choosing to sleep and/or a need to sleep.

I used to lay in on weekends and at every opportunity, since my condition I

relish the chance I get to be awake.

Once you lose control of your sleep, the novelty wears off.

8th december 2010 - 18:14

I have had KLS for almost 11 years and it brings your life to a stand still. I

have experienced both the 16-20 hours of sleep a day for up to 2 weeks and

extreme exhaustion for up to 6 months. One is a brief coma the other is a coma

that you are awake for. You can't do anything while awake. Medications didn't

work. I went to a sleep specialist to find help. Strict sleeping schedules help

some.

8th december 2010 - 14:06

I think its great that Louisa doesnt let this get in the way of her life, or

get her down. I think its a bit worrying that people may call her lazy,

teenagers can be lazy but sleeping for 10 days is not normal. Imagine any of us

just being hit with this sleep disorder, just stop and think of how damaging it

could be to your life, if you have children for instance, or a career! Have

some sympathy!!