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Clinically Oriented Approach to Childhood Insomnia: A case of drug refractory childhood Insomnia responsive to a Over The Counter Medication
Childhood insomnia still is a challenging diagnosis. Although apparently secondary to child and caregiver relationship, there are current evidence that supports a clinically oriented approach. As different cases of insomnia with organic etiology may have different pathophysiology and better respond to specific drug approaches, when needed.
The aim to report a case of a 2 year old child with Edwards Syndrome and refectory insomnia that responded only to an Over the Counter Medication.
Meetings with parents and patient were conducted in Children’s Institute (University of Sao Paulo Medical School) Pediatric Sleep Clinic.
The patient is a 2 years-old female, who came to Pediatric Sleep Clinic with her parents, and a previous diagnosis of Edwards Syndrome and cow's milk protein allergy. The parents complaint was that the patient had frequent arousals during the main sleep period and was unable to stay longer than 2h sleeping. Patient went to bed at 20h and had one arousal every 15min to 2 hours, crying, and returned to sleep after a few minutes. She was in a diet free of cow's milk and its derivates. She also had difficulties in falling asleep and was diagnosed as a combined type of insomnia (both with difficulties falling and maintaining sleep). She had been using Zolpidem, Periciazine, Risperidone, Chlorpromazine and Morphine for this insomnia with no improvement on sleep pattern. After a clinically oriented approach and psychoeducation for sleep hygiene and behavioral techniques she had little improvement. Two weeks later, hydroxyzine 2ml at 23h was introduced with a good response. The number of arousals lowered to once per night.
Clinically oriented approach of insomnia is a more comprehensive approach that accounts clinical questions and behavioral issues to subtyping insomnia into three main probable physiologic pathways involved in childhood insomnia (serotoninergic, histaminergic and dopaminergic). The patient had no response to previous drugs, including hypnotic agents. However, when hydroxizyne was introduced, the patient began responding, which shows that in this case, the hystaminergic might have a correlation with the physiopathology.
childhood insomnia, Edward-syndrome, hydroxyne, histaminergic system
Relato de Caso
Bruno Sérgio Vasconcellos, Viviane Vieira Passini, Marcela Yanagimori, Cássio Batista Lacerda, Mariana Delgado Fernandes, Thais Cano, Camila Bae Uneda, Camila Bae Uneda, Ila Marques Porto Linares, Ila Marques Porto Linares, Leticia Maria Satnoro Franco Azevedo Soster, Clarissa Bueno, Clarissa Bueno