• Users Online: 402
  • Print this page
  • Email this page

 Table of Contents  
Year : 2022  |  Volume : 3  |  Issue : 2  |  Page : 60-68

Kleine − Levin syndrome: An ayurvedic perspective

Department of Kaya Chikitsa, R. B. Ayurvedic Medical College and Hospital, Agra, Uttar Pradesh, India

Date of Submission12-May-2022
Date of Decision12-Nov-2022
Date of Acceptance14-Nov-2022
Date of Web Publication12-Dec-2022

Correspondence Address:
Prasad Mamidi
Department of Kaya Chikitsa, R. B. Ayurvedic Medical College and Hospital, Agra, Uttar Pradesh
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijaim.ijaim_22_22

Rights and Permissions

Kleine − Levin syndrome (KLS), also known as sleeping beauty syndrome, is characterized by the classic triad of hypersomnia, hyperphagia, and hypersexuality. It is an intriguing and severe disease with no clear etiology or management. The present study aims for better understanding of KLS according to Ayurveda and to propose an Ayurvedic management protocol for it. The present study has explored the similarity between KLS and an Ayurvedic diagnostic entity, Bhutonmada, or Grahonmada. Bhutonmada is the most suitable provisional diagnosis for the patients of primary KLS. Yaksha Grahonmada is the most perfect match for KLS though some of the clinical features are dissimilar. Bhutonmada Chikitsa as explained in Ayurvedic texts could be implemented to manage KLS. Panchakarma (Ayurvedic detoxification) procedures, Daiva Vyapashraya Chikitsa, Sattvavajaya Chikitsa, Achara Rasayana along with medications may play an important role in the management of KLS. Hypersomina episodes of KLS could be managed with Ati Nidra Chikitsa. The present work provides new insights and also paves the path for future research works for better understanding and managing the KLS in Ayurveda.

Keywords: Bhutonmada, grahonmada, hyperphagia, hypersexuality, hypersomnia, Kleine − levin syndrome

How to cite this article:
Mamidi P, Gupta K. Kleine − Levin syndrome: An ayurvedic perspective. Indian J Ayurveda lntegr Med 2022;3:60-8

How to cite this URL:
Mamidi P, Gupta K. Kleine − Levin syndrome: An ayurvedic perspective. Indian J Ayurveda lntegr Med [serial online] 2022 [cited 2023 Jun 6];3:60-8. Available from: http://www.ijaim.in/text.asp?2022/3/2/60/363109

  Introduction Top

Kleine − Levin syndrome (KLS) also known as “Sleeping beauty syndrome” is a rare disease characterized by the classic triad of hypersomnolence, hyperphagia, and hypersexuality.[1] KLS is an unique disease having unpredictable and spontaneous course. Clinical examination was unremarkable in all primary KLS cases. KLS may be more severe in secondary and female cases.[2] KLS is an intriguing, homogenous and severe disease, that has been known for more than a century, with no clear cause or treatment.[3] The prevalence of KLS is 1–5 cases per million population and men are affected more than women (2:1).[1],[2],[3] KLS is characterized by relapsing and remitting episodes of hypersomnia associated with other core symptoms such as cognitive dysfunction, altered perception, eating disorders, disinhibition, apathy, hallucinations, delusions, and headache. Hypersomnia is a mandatory symptom amongst all.[4] KLS has a benign clinical course with spontaneous disappearance of symptoms. There is no established treatment for KLS during episodes and inter-episodic periods. Various medications have shown inconsistent benefits in the management of KLS.[3]

Ayurvedic diagnosis and management of KLS is still obscure and no studies have been published on it till now. The present study aims to answer the questions like “What is KLS according to Ayurveda”? and “How KLS could be managed with Ayurveda? The aim of this study is to characterize an Ayurvedic perspective on the etiology, clinical features, course and prognosis, diagnosis, and management for KLS. The present work uses the model of Bhutonmada or Grahonmada (a broad category of various psychiatric and neuropsychiatric conditions having an idiopathic origin) to understand the disease KLS and to develop an Ayurvedic management protocol for it. The present work is an attempt to thoroughly understand KLS and interpret it in terms of Ayurvedic principles, considering all the possible views. The present work has potential implications for therapy and research on KLS in Ayurveda and it will highlight a number of new avenues that could be explored in future studies.

  Methodology Top

Various Ayurvedic classical texts such as Charaka Samhita with Chakrapani commentary, Sushruta Samhita with Dalhana commentary, Ashtanga Samgraha with Indu commentary, Ashtanga Hrudaya with Arunadatta and Hemadri commentaries, Madhava Nidana with Madhukosha commentary, Bhava Prakasha, Bhaishajya Ratnavali etc., have been referred for Ayurvedic literature. Web-based search engines and various electronic databases have been searched to find out relevant studies on KLS, Unmada, Bhutonmada, Grahonmada and Tandra. Key words such as, “KLS”, “KLS”, “Ayurveda”, “Ayurveda and KLS”, “Unmada”, “Bhutonmada”, “Grahonmada”, “Tandra”, “Ati Nidra”, “Nidra” etc., have been used while searching databases. Articles published in the English language were only considered.

  Discussion Top

The KLS is characterized by the recurrent episodes of hypersomnia, cognitive or behavioral disturbances, compulsive eating behavior, and hypersexuality. Schmidt has established the following diagnostic criteria for KLS: male predominance with adolescent onset, periodic hypersomnia, mega or hyper or polyphagia, psychological and behavioral changes, benign clinical course with spontaneous remission of symptoms, and lack of other psychiatric or neurological illness. The KLS is classified into primary and secondary.[3]

Etiology and precipitating factors of Kleine − Levin syndrome

The etiology of KLS is unknown. Recurrent events are found to be triggered by infection, fever, psychological stress, and sleep deprivation. An autoimmune mechanism has also been suggested. There are likely heterogeneous factors at play in certain susceptible individuals.[5] Electroencephalographic slowing during episodes, diffuse brain hypoperfusion, viral infections, abnormalities in neurotransmitter metabolism, and perinatal complications have been found in KLS patients. Spontaneous disappearance of the symptoms and also the mechanisms determining its periodicity in KLS patients are still mysterious.[3] A purely psychological etiology, physical trauma, and toxins are also considered as the possible causes for KLS.[6] Primary KLS may develop insidiously. Various precipitating factors such as a flu-like illness, a nonspecific fever, an upper respiratory tract infection, tonsillitis, gastro-enteritis, severe infection, head trauma, physical exertion, psychological distress, surgery with anesthesia, lactation, and menstruation were reported by KLS patients at onset occasionally.[2]

Course and prognosis of Kleine − Levin syndrome

The KLS is characterized by the episodes of hypersomnia separated by intervening periods of normal behavior. The frequency of reoccurrences varies among KLS patients. Episodes of hypersomnia usually recur more often during the initial stages of disease onset. As KLS progresses and the patient ages, the length of the episodes increases. As the KLS progresses, symptoms tend to wane in severity and also they spontaneously resolve in adolescent onset patients. The KLS is less likely to resolve in adult onset patients.[5] The duration of primary KLS ranges from 6 months to 41 years. KLS as a disease may last for 8 years.[2]

Clinical features of Kleine − Levin syndrome

KLS is characterized by the recurrent episodes of severe hypersomnia with behavioral and cognitive disturbances such as derealization, confusion, compulsive eating, apathy, and hypersexuality. Episodes may last for a few days to many weeks and are intervened by weeks or months of normal behavior and sleep. The KLS is categorized as a central disorder of hypersomnolence.[7]


Hypersomnia is a major clinical feature of KLS and it is mandatory for diagnosis.[2] Prolonged duration of sleep with a median 18 h sleep/day can be found. Most patients of KLS are difficult to awaken though they remain alert. The KLS patients may wake up spontaneously to eat and void.[4] Patients complain of excessive daytime sleepiness during episodes.[5] KLS patients may complain of sudden overwhelming tiredness, feeling drawn toward bed, and reluctant to get up in the morning. They were aggressive or irritable when prevented or awakened from sleep. The need for sleep is very intense in KLS patients.[3]


The majority of KLS patients usually eat a larger amount of food (megaphagia) with a preference for atypical food choices and sweets (food cravings). Patients may eat any food that is presented to them. Increased food intake in KLS patients, range from a mild increase to 6–8 meals a day.[3] KLS patients eat compulsively and they favor sweets.[5] Some KLS patients would eat things they would have refused in the past. KLS patients may eat compulsively, without complaints of hunger or expression of satiety.[2]


Hypersexuality-related symptoms such as increased masturbation, obscene language, exposing oneself, fondling genitalia, and making unwanted sexual advances can be seen in nearly half of the male KLS patients. Sexual disturbances are more variable and may occur only in a subset of episodes.[2] Hypersexuality is more common in males compared to females and takes the form of increased sexual drive, comments, advances, etc.[5]

Cognitive disturbances

Cognitive disturbances such as confusion, attention, concentration, and memory defects can be found in KLS patients. The various types of speech abnormalities such as being mute, using short or monosyllabic sentences, using limited vocabulary, slow to comprehend and to speak, having muddled, slurred, incoherent speech, using childish stereotypical language, verbal perseverations, echoing questions, etc., were reported in KLS patients. Many patients of KLS have reported amnesia of the events occurred during an episode, memory dysfunction, academic decline, temporal and spatial disorientation, and altered perception affecting all the senses.[3] Altered perception such as temperature sensation and pain insensitivity has been reported in KLS patients. They have difficulty with communication, executive functioning, working memory, long-term memory deficits, and visuospatial dysfunction.[5] Anterograde amnesia, lower logical reasoning, lower nonverbal intelligence quotient, slower speed of processing, and reduced retrieval strategies in episodic verbal memory were reported in KLS patients.[4]

Irritability and mood disorders

Flattened affect and depressive mood affect nearly half of the KLS patients during episodes. Anxiety is reported by the maximum number of the KLS patients during an episode. A striking apathy affects nearly all KLS patients.[4] Some KLS patients reported having suicidal thoughts. A few KLS cases reported to be hypomanic. Irritability can occur especially when sleep, sexual, or food drive are prohibited. Severe aggressive behaviors with verbal outbursts can also be found in KLS patients.[2] KLS patients often show transient depression, anxiety, suicidal ideation, and suicidal attempts.[5]

Delusions, hallucinations, and derealization

KLS patients may experience paranoid delusions, auditory or visual hallucinations and feelings of unreality or altered perception (unpleasant or bizarre or wrong). Objects may be perceived by KLS patients as to be a long way off and voices to be distant.[3] KLS patients report a feeling of derealization or “déjà vu”, as if they are experiencing life outside of their own bodies or as they are in a dream-like state.[5] Derealization in KLS patients may link to hypoactivity of the right temporoparietal junction.[4]

Other features

Abnormal or odd behavior and personality changes are seen in KLS patients.[5] Various compulsive and repetitive behaviors such as inappropriate and compulsive, body rocking, chewing lips, compulsive writing, pacing, wringing hands, the compulsion to set fire, nail-biting, hair pulling, scratching skin, laughing and crying, walking along straight lines, etc., are seen in KLS patients. Neurological signs such as sensory disturbances of the extremities, mental retardation, frontal, pseudo-bulbar and pyramidal syndromes, hemiplegia, parkinsonism, facial palsy, upward-gaze palsy, etc., can be seen in KLS patients.[2]

KLS patients also present with insomnia, photophobia, painful hyperacusis, and other autonomic features.[4]

Ayurvedic diagnosis of Kleine − Levin syndrome

There is no such condition in Ayurveda that exactly matches with KLS. There are three conditions documented in Ayurvedic classical texts, i.e., Ati Nidra (hypersomnia),[8],[9]Tandra” (a disease characterized by hypersomnia),[10] and “Unmada”[11],[12],[13],[14],[15],[16],[17],[18],[19],[20],[21],[22],[23],[24],[25],[26],[27],[28],[29],[30],[31],[32],[33],[34] that are closest matches to KLS. While searching for an approximate match or a similar pathological condition in Ayurvedic classical texts for an established disease of Allopathy or western medicine (such as KLS), similarity needs to be checked on various factors such as etiology, pathology, mode of onset, course and prognosis, and clinical features. The similarities and dissimilarities in between these Ayurvedic diagnoses (Ati Nidra, Tandra, and Bhutonmada) and KLS have been explored in the following sections.

Ati Nidra and Kleine − Levin syndrome

Nidra (sleep) is considered one among the three life sustaining factors (Trayopastambha). Nidra is caused by Tamo Guna (an attribute or quality related to darkness or ignorance).[35] The pathological types of sleep such as “Aamaya Kheda Prabhava Nidra” (hypersomnia due to medical conditions), “Chitta Kheda Prabhava Nidra” (hypersomnia due to psychiatric diseases), “Tamo Bhava Nidra” (due to excessive Tamo Guna),[36] and “Vyadhyanuvartini Nidra” (hypersomnia due to medical or psychiatric diseases)[37] may denote secondary hypersomnia. Ati Nidra has been correlated with hypersomnia, narcolepsy, and obstructive sleep apnea that includes increased sleep duration at night and excessive daytime sleep. Ati Nidra is one of the features of excessive Rasa Dhatu (component of the body with nutrients and essence), Kapha (one of the biological humor) and Tamo Guna, and it is responsible for Nidraalutvam (excessive sleep). Ati Nidra is considered as Kaphaja Naanaatmaja Vikaara (diseases with Kapha predominance).[9] Ati Nidra is one of the symptoms of many disease conditions rather than an independent disease having its own unique etiology, pathogenesis, clinical features, and management. Hence, it cannot be considered as a match to KLS.

Tandra and Kleine − Levin syndrome

Tandra is characterized by reduced acuity of perception (Indriyaartheshu Asamvitti), feeling of heaviness (Gauravam), yawning (Jrumbhanam), tiredness or fatigue or exhaustion (Klama), and excessive drowsiness or sleepiness (Nidraartasyeva). Nidra Vega Dhaarana (withholding the intense urge to sleep) may lead to the manifestation of Tandra. Tandra is characterized by intense urge for sleep and it is correlated with stupor. It is caused by the increase of Tamo Guna, Vaata (one of the biological humor) and Kapha.[38] It can be correlated with an intense urge to sleep and excessive drowsiness and it is one of the prodromal symptoms of Prameha (diabetes). It is also a symptom of many diseases such as Kaphaja Chardi (vomiting), Kaphaja and Kardama Visarpa (a type of skin disease), Jangama Visha (animate poison) and Dhwamsaka Roga (a type of alcohol use disorder).[39] Tandra is mentioned as an independent disease entity in “Madhava Nidana.”[10] Except, the hypersomnia or an intense urge to sleep no other clinical features of KLS can be seen in the description of Tandra. Hence, Ati Nidra and Tandra cannot be correlated with KLS.

Similarity between Bhutonmada and Kleine − Levin syndrome

There is profound similarity found between an Ayurvedic diagnostic entity, i.e., Bhutonmada and KLS on multiple domains such as etiology, pathophysiology [Table 1], clinical features [Table 2]. The similarity between Bhutonmada and KLS has been elaborated in the following text [Table 1] and [Table 2]. Unmada (a broad spectrum that includes various psychiatric disorders) is a major psychiatric illness documented in all Ayurvedic classical texts. In Unmada, the impairment of cognitive functions can be seen across multiple domains such as Manas (mind), Buddhi (cognition), Sangna Gnanam (perception/orientation), Smriti (memory), Bhakti (desires/interests), Sheela (personality), Cheshta (psychomotor activity), and Achaara (conduct). There is a considerable diversity of opinion among various Ayurvedic scholars regarding the classification of Unmada.[11],[12],[13] Unmada is classified into five types, i.e., Vataja, Pittaja, Kaphaja, Sannipataja and Agantuja (by Acharya Charaka),[15] and six types, i.e., Vaataja, Pittaja, Kaphaja, Sannipataja, Vishaja, and Dukhaja/Aadhija (by Acharya Sushruta,[40] Vagbhata,[41],[42] Madhavakara[43] and Bhavamishra).[44]
Table 1: Comparison of etiopathological factors between Kleine-Levin syndrome and Grahonmada

Click here to view

Bhutonmada or Grahonmada (various idiopathic neuropsychiatric conditions) is caused by affliction of Graha or Bhuta (a microbe or an evil spirit or an idiopathic factor). The cause of affliction of Bhuta is Pragnaparadha (intellectual blasphemy) and Karma (consequences of bad deeds). The onset of Bhutonmada is sudden and its course is unpredictable. Bhutonmada is characterized by abnormal or inappropriate behaviors, perceptual abnormalities, memory deficits, inappropriate speech, abnormality of self-perception, and the environment. There is a considerable diversity of opinion among various Ayurvedic scholars regarding the types of Bhutonmada.[33] The description of eight types of Bhutonmada (Deva, Asura, Gandharva, Yaksha, Pitru, Naaga, Rakshasa, and Pishacha) is available in Sushruta Samhita, 11 types in Charaka Samhita (Deva, Rishi, Guru, Vriddha, Siddha, Pitru, Gandharva, Yaksha, Rakshasa, Brahma Rakshasa, and Pishacha) and 18 types as per Ashtanga Samgraha and Ashtanga Hridaya (Deva, Asura, Rishi, Guru, Vriddha, Siddha, Pitru, Gandharva, Yaksha, Rakshasa, Sarpa, Brahma Rakshasa, Pishacha, Kushmanda, Nishaada, Preta, Maukirana, and Vetaala).[17] Grahonmada described in classical Ayurvedic texts have shown resemblance with various psychiatric and somatopsychiatric conditions of contemporary psychiatry.[17],[18],[19],[20],[21],[22],[23],[24],[25],[26],[27],[28],[29],[30],[31],[32],[33],[34]

Causative factors are not traceable in Bhutonmada and there is no specific etiology mentioned for it. Karma and Pragnaparadha play an important role in the manifestation of Bhutonmada. Predisposing factors such as vulnerable personality traits have been mentioned in the context of Bhutonmada. It can also occur as a condition of another disease such as Unmada, Apasmara (epilepsy), and Jwara (fever). Affliction of Bhuta' or Graha' happens at specific time and those specific time is called as Chidra Kaala' (precipitating factors for Bhutonmada). While indulging sinful activities, not following code of conduct, during illness, perinatal period of time and during severe stressful situations are some of the examples of Chidra Kaala'. Chidra kaala are traumatic and stressful life events, which may precipitate the manifestation of Bhutonmada. Similar to Bhutonmada, in KLS also the etiology is unknown and in some cases precipitating factors have been found.[2],[3]

Mano Vibhrama is characterized by abnormal thinking patterns.[17] “Slow thinking” has been reported in KLS patients.[45] Thought disorders are frequently associated with the critical symptomatology, and they may suggest comorbidity of KLS with other psychiatric diagnoses such as schizophrenia.[46] A feeling of unreality or disconnected thinking during the episodes were reported by most patients with KLS and felt to be the most crucial symptom of the syndrome.[2],[3] Buddhi usually denotes cognitive functions such as comprehension, intellect, knowledge, understanding, discrimination, and judgment. Buddhi Vibhrama represents abnormality of intellect that causes loss of discriminating power and leads to interpreting real things as unreal and useful things as harmful or vice versa. Person having Buddhi Vibhrama gets confused about what is good or bad and will take wrong or unhealthy decisions.[17] Majority of KLS patients have shown cognitive disturbances (Buddhi Vibhrama) such as confusion, concentration, and attention impairments.[3] Cognitive impairment (Buddhi Vibhrama) is one of the key symptoms of KLS.[5] Abnormal speech, academic decline, temporal and spatial disorientation, delusions, derealisation (Buddhi Vibhrama) features have been seen in KLS patients.[3] Sangna Gnanam denotes perception or orientation or recognizing objects or surroundings exactly. Sangna Gnana Vibhrama indicates altered perception and that is one of the key features of KLS. Feeling the objects or surroundings as unreal and dreamlike states are some of the perceptual abnormalities (Sangna Gnana Vibhrama) seen in KLS patients. Nightmarish sense of the surroundings, depersonalization, anguish, sense of unreality and disconnection, auditory and visual hallucinations, altered temperature sensation, and pain insensitivity are some of the perceptual impairments (Sangna Gnana Vibhrama) reported by the patients of KLS.[2],[3],[5]

Long-term memory deficits, impairment of working memory, and reduced retrieval strategies in eatypical verbal memory in KLS patients[2],[3] is similar to Smriti Vibhrama (memory impairments). Bhakti denotes desires or interests or inclination or preferences, and sudden unexplainable changes of them are considered as Bhakti Vibhrama.[17] Clinical features seen in KLS such as increased food intake with a preference for sweets, atypical food choices, excessive sleep, and increased sexual drive[2],[3] are similar to Bhakti Vibhrama. Personality changes, behavioral changes (disinhibited behavior, apthy, aggressiveness, inappropriate/odd behaviors, irritability, etc.), and compulsions seen in KLS[5] could be considered as Sheela Vibhrama, Achara Vibhrama, and Cheshta Vibhrama, respectively. It seems that Vibhrama of Manas, Buddhi, Sangna Gnana, Smriti, Bhakti, Sheela, Cheshta and Achara can be seen in KLS patients. Spontaneous disappearance of the symptoms and also the periodicity in KLS is still mysterious.[3] Even in Bhutonmada, the symptoms occur suddenly without any obvious reason or sometimes triggered by Chidra Kaala' and the disease course is also unpredictable. The specific cause is not traceable for the manifestation and aggravation of symptoms. The prognosis of Bhutonmada is also unpredictable[17] like in KLS [Table 1].

Various clinical features of KLS can also be seen in different types of Bhutonmada' [Table 1]. Asakrit Swapna of Yaksha Grahonmada,[22] Nidraalu of Uraga Grahonmada,[27] Ati Nidraalum of Vetaala Grahonmada,[20] and Nidraalu of Pitru Grahonmada[31] resemble with hypersomnia seen in KLS. Anna Paana Ratim of Yaksha Grahonmada,[22] Yaachantam Annam of Maukirana Grahonmada,[29] Bhojanam Drushtva Hasantam of Kashmala Grahonmada,[33] Bahvashinam of Nistejas Grahonmada,[33] Kshudaadhikya,[32] and Bahvashinam of Pishacha Grahonmada denote hyper/mega/polyphagia seen in KLS patients. Shringaara Leelaabhiratam of Gandharva Grahonmada,[19] Stree Lolupam of Yaksha Grahonmada,[22] Stree Priyam of Rakshasa Grahonmada,[24] Nagnam Dhaavantam of Nishaada Grahonmada,[26] Striyo Maargo Rundhaanam of Nistejas Grahonmada,[33] Nagno Bhramantam, and Uddhvasta of Pishacha Grahonmada are similar to hypersexuality seen in KLS patients

Alpa Vaak of Deva Grahonmada,[23] Chaaru Chaalpa Shabdam of Gandharva Grahonmada,[19] Alpa Vaak of Yaksha Grahonmada,[22] Nirarthakam Paribhashanam of Rakshasa Grahonmada,[24] Aakroshinam of Brahma Rakshasa Grahonmada,[25] Bahu Pralaapam and Ugra Vaakyam of Kushmanda Grahonmada,[30] Parusha Abhidaayinam of Nishaada Grahonmada,[26] Ugra Vaadinam of Maukirana Grahonmada,[29] Akeerna Maunam of Vikata Grahonmada,[33] Mookavat Pravilokyate of Varuna Grahonmada,[34] Pratihata and Skhalata Vaacham of Pitru Grahonmada[31] are similar to various speech abnormalities found in KLS patients. Krodhanam and Vyavasaayinam of Daitya Grahonmada,[21] Chandam, Teekshnam and Prahasati of Gandharva Grahonmada,[19] Asakrit Haasya Rodana of Yaksha Grahonmada,[22] Krodham, Praharantam, Akasmaat Rudantam and Hasantam and Deenam of Rakshasa Grahonmada,[24] Haasa Priyam and Raudra Cheshtam of Brahma Rakshasa Grahonmada,[25] Krodhanam of Uraga Grahonmada,[27] Gruheetva Kaashta Loshtaadi Bhramanam and Shunya Nishevanam of Nishaada Grahonmada,[26] Kupyantam of Nistejas Grahonmada,[33] Rodanam and Deenata of Vaayu Grahonmada,[34] Nrutyati, Gaayati, Rauti, Deena Vadanam and Aswastha Chittam of Pishacha Grahonmada,[32] and Deena Vadanam of Pitru Grahonmada[31] are similar to irritability and mood disorders (depression and manic episodes) seen in KLS patients. Similarities among various other clinical features have also been found between KLS and Bhutonmada [Table 2]. Yaksha Grahonmada is the most suitable match among all different types of Bhutonmada' in terms of similarity in clinical presentation. By considering all these facts it can be said that Bhutonmada is the most probable diagnosis for KLS.
Table 2: Comparison of clinical features between Kleine-Levin syndrome and Bhutonmada

Click here to view

Ayurvedic management of Kleine − Levin syndrome

There is no established treatment for KLS.[3] Ati Nidra Chikitsa (treatment for hypersomnia) can be implemented in the management of hypersomnia episodes of KLS. Manifestation of Ati Nidra is due to excessive Kapha and Aama (undigested food or abnormal metabolites). This combination of Kapha and Aama leads to the obstruction of the Srotas (channels) and ultimately resulting in excess sleep.[9] Procedures such as Kaaya Virechana (therapeutic purgation), Shiro Virechana (nasal administration of medicines), Vamana (therapeutic emesis), Dhooma Paana (medicated smoke inhalation), Vyayama (exercises), Rakta Mokshana (bloodletting), Upavaasa (fasting), Sattvaudaarya, and Tamojaya (increasing Sattva Guna and reducing Tamo Guna by practicing Yoga and meditation) are beneficial in managing hypersomnia.[8] Teekshna Anjana (collyrium) is also a beneficial procedure in the management of hypersomnia.[9]

Bhutonmada Chikitsa should be implemented in the management of KLS as there is a profound similarity between KLS and Bhutonmada. Puja (worship), Bali (offerings), Upahaara (tributes), Shaanti Vidhi (reciting or chanting of hymns to get rid of evil or bad Karma), Homa (Vedic ritual), Mantra (Vedic hymns), Daanam (charity/donation), Swastyayanam (Mantra recited for good luck), Vrata (holy practices or customs), Niyama (practices of selfrestraint), Satyam (truthfulness), Japa (meditation), Mangalam (auspicious activities), Praayashchitta (atonement), Anjana (collyrium), Ratna and Aushadhi Dhaarana (wearing precious stones and amulets), Bhootaanurupa Ishta Charanam (activities tailored according to specific Bhutonmada), Shivaarchanam (worshipping Lord Shiva), etc., are mentioned as some of the procedures to tackle Bhutonmada. Various formulations such as Saraswata Choornam, Unmada Parpati Ras, Unmada Bhanjani Vatika, Unmada Gaja Kesari Ras, Unmada Gajankusha Ras, Unmada Bhanjana Ras, Bhutamkusha Ras, Chaturbhuja Ras, Hingwadi Ghrtiam, Lashunadi Ghritam, Kalyanaka Ghritam, Maha Kalyanaka Ghritam, Swalpa Chaitasa Ghritam, Maha Paishachika Ghritam, and Shiva Ghritam are mentioned in the management of Unmada and they may be useful in Bhutonmada also.[47]

Daiva Vyapashraya Chikitsa (traditional healing practices), Sattvavajaya Chikitsa (psychotherapy), and Yukti Vypashraya Chikitsa (treating with medicines and procedures/rational treatment) mentioned in Unmada Chikitsa context could be implemented in KLS. Sattvavajaya and Daiva Vyapashraya treatments should be main focus. In the presence of Doshaja symptoms (secondary Bhutonmada or Bhutonmada comorbid with some other psychiatric or organic disease), Yukti Vypashraya treatments need to be implemented. Adravya Bhoota Chikitsa (nondrug therapies) such as Bhaya Darshana (threatening), Vismaapana (surprising), Vismaarana (de-memorizing), Kshobhana (shock treatments), Harshana (exhilaration), Bhartsana (chiding) could also be implemented in the management of KLS. Following specified codes of conduct and adopting virtuous life style are an essential part in the management of Bhutonmada. Practices mentioned in the context of Achara Rasayana (virtuous code of conduct) also should be adopted in the management of KLS.[17] Ayurvedic management protocol for KLS should be prepared according to the clinical features. As there is no specific or established Ayurvedic treatment protocol for KLS, Bhutonmada Chikitsa can be implemented.

  Conclusion Top

KLS is an intriguing, severe disease with no clearly defined clinical features, cause and treatment. Bhutonmada is the most suitable provisional diagnosis for primary KLS and specific Bhutonmada can be considered under diagnosis based on the other associated clinical features. Yaksha Grahonmada is the best match for KLS. General or specific Bhutonmada Chikitsa could be implemented to manage KLS. Panchakarma (Ayurvedic detoxification) procedures, Daiva Vyapashraya Chikitsa, Sattvavajaya Chikitsa, Achara Rasayana along with medications may play an important role in the management of KLS. Hypersomina episodes of KLS could be managed with Ati Nidra Chikitsa. The present study provides new insights for the clinical implementation of Bhutonmada in diagnosing and managing of KLS. The present work also paves the path for future research works for better understanding and managing the KLS as per Ayurveda.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Shah F, Gupta V. Kleine-Levin syndrome (KLS). In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2022. Available from: https://www.ncbi.nlm.nih.gov/books/NBK568756/. [Last updated on 2021 Nov 20].  Back to cited text no. 1
Arnulf I, Zeitzer JM, File J, Farber N, Mignot E. Kleine-Levin syndrome: A systematic review of 186 cases in the literature. Brain 2005;128:2763-76.  Back to cited text no. 2
Ramdurg S. Kleine-Levin syndrome: Etiology, diagnosis, and treatment. Ann Indian Acad Neurol 2010;13:241-6.  Back to cited text no. 3
[PUBMED]  [Full text]  
Trotti LM, Arnulf I. Idiopathic hypersomnia and other hypersomnia syndromes. Neurotherapeutics 2021;18:20-31.  Back to cited text no. 4
Miglis MG, Guilleminault C. Kleine-Levin syndrome: A review. Nat Sci Sleep 2014;6:19-26.  Back to cited text no. 5
AlShareef SM, Smith RM, BaHammam AS. Kleine-Levin syndrome: Clues to aetiology. Sleep Breath 2018;22:613-23.  Back to cited text no. 6
de Oliveira MM, Conti C, Prado GF. Pharmacological treatment for Kleine-Levin syndrome. Cochrane Database Syst Rev 2016;2016:CD006685.  Back to cited text no. 7
Acharya JT, editor. Agnivesha, Elaborated by Charaka and Dridhabala, Commentary by Chakrapani. Charaka Samhita, Sutra Sthana, Ashta Ninditiyam Adhyaya, 21/55-62. Varanasi: Chaukhamba Surbharati Prakashan; 2014. p. 119-20.  Back to cited text no. 8
Vikas P, Gunjan S, Kumar PS. Review of Ayurvedic strategies to overcome Atinidra (hypersomnia) and improve quality of life. Int J Appl Ayurved Res 2020;4:893-9.  Back to cited text no. 9
Madhavakara. Rogavinischaya/Madhava Nidana, Murcha Bhrama Nidra Tandra Sanyaasa Nidana, 17/20, Telugu Translation by Gopalacharyulu D. 1st ed. Hyderabad: Prachee Publications; 1911. p. 142.  Back to cited text no. 10
Gupta K, Mamidi P. Vataja unmada: Schizophrenia or dementia or mood disorder with psychosis? Int J Yoga Philosop Psychol Parapsychol 2020;8:75-86.  Back to cited text no. 11
Mamidi P, Gupta K. Pittaja unmada: Hyperthyroidism with mania?/Psychotic or irritable mania? Int J Yoga Philosop Psychol Parapsychol 2020;8:47-57.  Back to cited text no. 12
Gupta K, Mamidi P. Kaphaja unmada: Myxedema psychosis? Int J Yoga Philosop Psychol Parapsychol 2015;3:31-9.  Back to cited text no. 13
Gupta K, Mamidi P. Madonmada of Bhela samhita: Trauma-and stressor-related disorders? J Appl Conscious Stud 2022;10:42-9.  Back to cited text no. 14
  [Full text]  
Acharya JT, editor. Agnivesha, Elaborated by Charaka and Dridhabala, Commentary by Chakrapani. Charaka Samhita, Nidana Sthana, Unmada Nidanam Adhyaya, 7/1-24. Varanasi: Chaukhamba Surbharati Prakashan; 2014. p. 223-4.  Back to cited text no. 15
Acharya JT, editor. Agnivesha, Elaborated by Charaka and Dridhabala, Commentary by Chakrapani. Charaka Samhita, Chikitsa Sthana, Unmada Chikitsitam Adhyaya, 9/11-98. Varanasi: Chaukhamba Surbharati Prakashan; 2014. p. 470-4.  Back to cited text no. 16
Mamidi P, Gupta K. Obsessive compulsive disorder – 'Sangama Graha': An Ayurvedic view. J Pharm Sci Innov 2015;4:156-64.  Back to cited text no. 17
Mamidi P, Gupta K. Guru, vriddha, rishi and siddha grahonmaada: Geschwind syndrome? Int J Yoga Philosop Psychol Parapsychol 2015;3:40-5.  Back to cited text no. 18
Gupta K, Mamidi P. Gandharva grahonmada: Bipolar disorder with obsessive-compulsive disorder/mania? Int J Yoga Philosop Psychol Parapsychol 2017;5:6-13.  Back to cited text no. 19
Mamidi P, Gupta K. Vetaala grahonmada: Parkinson's disease with obsessive-compulsive disorder?/Autoimmune neuropsychiatric disorder? Int J Yoga Philosop Psychol Parapsychol 2017;5:35-41.  Back to cited text no. 20
Gupta K, Mamidi P. Deva shatru/Daitya/Asura grahonmada: Antisocial/Narcissistic/Borderline personality disorder? Int J Yoga Philosop Psychol Parapsychol 2018;6:10-5.  Back to cited text no. 21
Gupta K, Mamidi P. Yaksha grahonmada: Bipolar disorder with obsessive-compulsive disorder? Int J Yoga Philosop Psychol Parapsychol 2018;6:16-23.  Back to cited text no. 22
Gupta K, Mamidi P. Deva grahonmada: Interictal behavior syndrome of temporal lobe epilepsy?/Obsessive-compulsive disorder with mania? Int J Yoga Philosop Psychol Parapsychol 2018;6:41-50.  Back to cited text no. 23
Mamidi P, Gupta K. Rakshasa grahonmada: Antisocial personality disorder with psychotic mania? Int J Yoga Philosop Psychol Parapsychol 2018;6:24-31.  Back to cited text no. 24
Mamidi P, Gupta K. Brahma rakshasa grahonmada: Borderline personality disorder?/Tourette syndrome – Plus? Int J Yoga Philosop Psychol Parapsychol 2018;6:32-40.  Back to cited text no. 25
Gupta K, Mamidi P. Nishaada grahonmada: Behavioral and pscyhological symptoms of dementia?/Frontotemporal dementia?/Hebephrenia? J Neuro Behav Sci 2018;5:97-101.  Back to cited text no. 26
Mamidi P, Gupta K. Uraga grahonmada: Extrapyramidal movement disorder?/Tourette syndrome – Plus? Indian J Health Sci Biomed Res 2018;11:215-21.  Back to cited text no. 27
  [Full text]  
Gupta K, Mamidi P. Preta grahonmada – Catatonia? Med J DY Patil Vidyapeeth 2018;11:461-5.  Back to cited text no. 28
  [Full text]  
Mamidi P, Gupta K. Maukirana grahonmada – Psychiatric manifestations of Graves' hyperthyroidism and ophthalmopathy? Med J DY Patil Vidyapeeth 2018;11:466-70.  Back to cited text no. 29
  [Full text]  
Gupta K, Mamidi P. Kushmanda grahonmada – Paraneoplastic neurological syndrome with testicular cancer? J Neuro Behav Sci 2018;5:172-6.  Back to cited text no. 30
Gupta K, Mamidi P. Pitru grahonmada: Vitamin B12 deficiency-induced neuropsychiatric manifestations? Int J Yoga Philosop Psychol Parapsychol 2021;9:59-66.  Back to cited text no. 31
Mamidi P, Gupta K. Pishacha grahonmada – Frontotemporal dementia with vitamin B12 deficiency? AYUHOM 2020;7:47-54.  Back to cited text no. 32
  [Full text]  
Mamidi P, Gupta K. Vishesha or Upa Grahonmadas: Various psychiatric and neuropsychiatric conditions. Int J Yoga Philosop Psychol Parapsychol 2021;9:23-31.  Back to cited text no. 33
Gupta K, Mamidi P. Bhutonmada's of Harita samhita – An explorative study. Int J Yoga Philosop Psychol Parapsychol 2020;8:3-12.  Back to cited text no. 34
Desai P, Sawarkar G, Yelne U. Managing sleep disorders in the elderly with Ayurveda. Int J Ayurveda Pharma Res 2016;4:48-51.  Back to cited text no. 35
Girhepunje KS, Gupta V, Jain R, Nakanekar A, Singh OP. A concept of daytime sleeping (Diwaswap) in Ayurveda in the pathogenesis of various metabolic disorders: A scientific approach. Int J Ayu Pharm Chem 2017;8:16-30.  Back to cited text no. 36
Kanap PP, Joshi M. Study the physiology of Nidra (sleep) and its applied aspects. J Emerg Technol Innov Res 2021;8:a657-60.  Back to cited text no. 37
Kulkarni P, Vaidya SM. Physiological aspect of Nidra with special reference to sleep. World J Pharm Med Res 2019;5:72-4.  Back to cited text no. 38
Prajapati S, Paliwal M. Significance of sleep: Ayurvedic perspective. Int J Health Sci Res 2019;9:240-5.  Back to cited text no. 39
Acharya VJ, Acharya NR, editor. Sushruta. Sushruta Samhita, Commentary by Dalhana. Uttara Tantra, Unmada Pratishedha Adhyaya, 62/1-10. Varanasi: Chaukhamba Orientalia; 2009. p. 803-4.  Back to cited text no. 40
Murthy KR, edited & English translation. Vriddha Vagbhata. Ashtanga Sangraha, Uttara Tantra, Unmada Pratishedha Adhyaya. 1st ed., Vol. 3. Varanasi: Chowkhamba Orientalia; 2012. p. 89.  Back to cited text no. 41
Paradkara Vaidya BH, editor. Vagbhata. Ashtanga Hridaya, Commentary by Arunadatta and Hemadri, Uttara Tantra, Unmada Pratishedham Adhyaya, 6/1-17. 9th ed. Varanasi: Chowkhamba Sanskrit Series Office; 2005. p. 798.  Back to cited text no. 42
Tripathi B, editor. Madhavakara. Rogavinischaya/Madhava Nidana, Unmada Nidana, 20/1-12, Commentary 'Madhukosha' by Vijayarakshita & Shrikanthadatta. 1st ed. Varanasi: Chaukhamba Surbharati Prakashan; 2012. p. 474-95.  Back to cited text no. 43
Murthy KR, edited and English translation. Bhavamishra. Bhavaprakasha, Unmadadhikarah. 3rd ed., Vol. 2. Varanasi: Choukhamba Krishnadas Academy; 2006. p. 302.  Back to cited text no. 44
de Araújo Lima TF, da Silva Behrens NS, Lopes E, Pereira D, de Almeida Fonseca H, Cavalcanti PO, et al. Kleine-Levin syndrome: A case report. Sleep Sci 2014;7:122-5.  Back to cited text no. 45
Masi G, Favilla L, Millepiedi S. The Kleine-Levin syndrome as a neuropsychiatric disorder: A case report. Psychiatry 2000;63:93-100.  Back to cited text no. 46
Sen GD. In: Mishra SN, editor. Bhaishajya Ratnavali, Unmada Roga Adhikaara, 24/109-111. 1st ed., Vol. 2. Varanasi: Chaukhamba Surbharati Prakashan; 2014. p. 511.  Back to cited text no. 47


  [Table 1], [Table 2]


Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

  In this article
Article Tables

 Article Access Statistics
    PDF Downloaded143    
    Comments [Add]    

Recommend this journal