What is Alternating Hemiplegia : Causes, Symptoms, Treatment, Prognosis

Alternating Hemiplegia is a rare pathological condition of the musculoskeletal system in which a child has episodes of severe weakness affecting one side of the body.¹ This weakness may affect all the muscles or some muscles of the body. Once the episode is over, the child regains the strength back but will again have the same weakness when another episode of Alternating Hemiplegia strikes.

Alternating Hemiplegia is quite variable in the way if affects children and to the degree the child has the weakness. This makes this condition quite difficult to diagnose and treat. The treatment for Alternating Hemiplegia is basically treating the child when there is an episode.

There is no clear etiology for Alternating Hemiplegia as of yet, but this condition is believed to be very rare affecting about 1 in a million children. The child will start experiencing symptoms of Alternating Hemiplegia by the time he or she is three to four years of age and will wax and wane with time.

Apart from the unilateral weakness as stated above, there are other symptoms as well which are associated with Alternating Hemiplegia.² The bulbar region of the body which basically controls swallowing and speaking may get affected due to Alternating Hemiplegia. The affect may be to such a degree that the child may have to be treated in an inpatient setting before the episode wanes and the child gets back to baseline, especially when the child is having breathing problems or suffers from dehydration due to not being able to eat properly because of the episode of Alternating Hemiplegia.

Some of the long term problems associated with Alternating Hemiplegia are learning difficulties, behavioral problems, spasticity, dystonia, and dyspraxia. These symptoms tend to be present at all times and are not dependent on whether there is an episode of Alternating Hemiplegia or not. In some cases, a child may also have epilepsy due to Alternating Hemiplegia and the seizures may occur during or in between episodes of Alternating Hemiplegia.

The major problem faced by doctors in diagnosing Alternating Hemiplegia is that most of the symptoms wax and wane with time and that this condition is extremely rare and hence there are higher chances that a diagnosis of Alternating Hemiplegia may be missed at least in the earlier phases of the disease condition.

There are no specific tests to diagnose Alternating Hemiplegia and a diagnosis is basically made according to the history and symptoms of the patient. It may take quite a long time for a confirmatory diagnosis of Alternating Hemiplegia to be made and may require intervention of multiple different specialists before other conditions causing the symptoms can be ruled out and a definitive diagnosis of Alternating Hemiplegia is made.

There is no cure for Alternating Hemiplegia and the treatment is aimed at managing the episodes and trying to prevent them and also managing the epilepsy that comes along with it.

For treating an episode of Alternating Hemiplegia it is important to know the warning signs that an episode is about to happen. The telltale signs of an impending episode of Alternating Hemiplegia are tiredness, frequent yawning, and feeling completely exhausted without much activity. Once the parent notices these signs then the best way to treat is put the child to sleep as sleep tends to reduce some weakness associated with Alternating Hemiplegia.

There are also certain medications that can help with the weakness like midazolam and melatonin. In cases where a child complains of pain during an episode then pain medication in the form of ibuprofen or Tylenol may help.

Coming to feeding difficulties during an episode of Alternating Hemiplegia, it is recommended that the child should be fed within 15 to 20 minutes of the beginning of the episode and also be given plenty of water to drink.

For breathing difficulties during an episode of Alternating Hemiplegia, it is recommended that the child be taken to a nearby emergency room or a hospital for treatment.

Epilepsy caused due to Alternating Hemiplegia should be managed by antiepileptic medications and frequent EEG monitoring to check on the status of the functioning of the brain.

To prevent episodes of Alternating Hemiplegia, the best way to do it is to identify the triggers that flare up an episode. These triggers are variable and differ from child to child and include cold exposure, stress, tiredness, hot climate, and respiratory infections. If these triggers are avoided and any form of respiratory infections is treated aggressively and timely then the episodes of Alternating Hemiplegia can be controlled to a significant degree. As stated above, antiepileptics are required for control of seizures. It has been noted that a calcium channel blocker is somewhat effective in lowering down the intensity and frequency of the episodes of Alternating Hemiplegia.

Children with mild form of Alternating Hemiplegia have a fairly good prognosis while those with severe form of this condition will have increased walking and intellectual problems which they will have to deal with. In some cases, it may become virtually impossible for a patient to walk unassisted due to Alternating Hemiplegia.

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