title: An unusual case of insomnia associated with Whipple encephalopathy: first case reported from Greece.
abstract: Whipple disease is a relapsing systemic illness caused by Tropheryma whippelii. Central nervous system involvement occurs in 5%-40% of all patients. Hypothalamic manifestations occur in 31% of Whipple encephalopathy, including polydipsia, hyperphagia, change in libido and insomnia. We report a case of a 48-year-old man with severe insomnia, depression, dementia, dysarthria, myoclonic movements of the limbs and ophthalmoplegia. The diagnosis of Whipple encephalopathy was confirmed by PCR analysis of blood and faeces. He received a full dose of antibiotic treatment. Despite clinical improvement, resolution of the lesions detected in MRI scan of the brain and negative results of the PCR in blood, faeces and cerebrospinal fluid six months later, insomnia persisted and finally subsided after the administration of carbamazepine (600 mg/day). Our case supports the finding that carbamazepine might be useful in the treatment of insomnia associated with Whipple encephalopathy.
authors.affiliation: Department of Neurology, University of Athens Medical School, Eginition Hospital, 74 Vas. Sophias Av., 11528, Athens, Greece. marpapgr@yahoo.co.uk
authors.forename: M
authors.initials: M
authors.lastname: Papadopoulou
authors.forename: M
authors.initials: M
authors.lastname: Rentzos
authors.forename: E
authors.initials: E
authors.lastname: Vagiakis
authors.forename: V
authors.initials: V
authors.lastname: Zouvelou
authors.forename: C
authors.initials: C
authors.lastname: Potagas
authors.forename: A
authors.initials: A
authors.lastname: Bonakis
authors.forename: S
authors.initials: S
authors.lastname: Chatzipanagiotou
authors.forename: A
authors.initials: A
authors.lastname: Ioannidis
authors.forename: C
authors.initials: C
authors.lastname: Nicolaou
authors.forename: D
authors.initials: D
authors.lastname: Vassilopoulos
mesh_terms: D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001927:Brain Diseases / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D002220:Carbamazepine / Q000627:therapeutic use*; D006115:Greece; D006801:Humans; D008297:Male; D008875:Middle Aged; D017286:Polysomnography; D007319:Sleep Initiation and Maintenance Disorders / Q000188:drug therapy / Q000209:etiology*; D016896:Treatment Outcome; D008061:Whipple Disease / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy
chemical_list: D018712:Analgesics, Non-Narcotic; D000900:Anti-Bacterial Agents; D002220:Carbamazepine