Alternating Hemiplegia Health Article

Symptoms of benign nocturnal alternating hemiplegia of childhood

Symptoms of benign nocturnal alternating hemiplegia of childhood may begin when the child is about two years of age. Boys appear to be more frequently affected than girls. Episodes may be preceded by several days by headache, abnormal irritability, and oppositional behavior. The actual episodes commence when a child is asleep, causing the child to awaken suddenly, screaming or crying and drooling. Although the child may appear to be awake, he or she usually does not respond normally to questions or commands. Usually only one side of the body appears limp and paralyzed. The episodes usually last about fifteen minutes, end with the child falling back into sleep, and are completely resolved when the child awakens again. Some children experience headache and vomiting with each episode, further underscoring the proposed link with migraine headache. Although children with this condition do not seem to exhibit any permanent effects of their hemiplegic episodes, and generally have normal intelligence, there does appear to be an increased risk of hyperactivity, irritability, and oppositional defiant disorder in children who experience episodes of benign nocturnal alternating hemiplegia of childhood.

Diagnosis

There are no available tests to definitively diagnose either form of alternating hemiplegia. These disorders are diagnosed by ruling out other possible reasons for a child's episodes and symptoms.

Treatment team

Children with the more benign form of alternating hemiplegia may not require an extensive treatment team, other than a neurologist to help in diagnosis. Children with the more severe form of alternating hemiplegia may require a neurologist, as well as other specialists to help with their progressive problems with walking, such as a physical and occupational therapist. Children with this disorder usually require a specialized educational setting.

Treatment

There is no cure for either form of alternating hemiplegia. A drug called flunarizine has been used to treat the more severe type of alternating hemiplegia, in an effort to decrease the frequency of hemiplegic episodes, as well as their duration and severity. Some researchers believe that decreasing the number and severity of attacks may improve the child's overall cognitive prognosis, by preventing damage to the brain.

Prognosis

The classic form of alternating hemiplegia has a poor prognosis, with progressively severe impairment of mobility and cognitive functioning, requiring long-term care. About half of all children with benign nocturnal alternating hemiplegia of childhood outgrow their episodes over time.