Alternate Hemiplegia definition and treatments.

Alternate hemiplegia is a very rare brain disorder that is only seen in young children, most who are less than 2 years old. The disorder typically presents at around 3-6 months with recurrent episodes of paralysis that may involve different part of the body on one or both sides. The paralysis may last for a few hours to a few days and then spontaneously resolve. Sometimes only one leg may be affected but other times the entire right side may be involved. The disorder is unpredictable and relapses are common.

In most cases, episodes of paralysis disappear after sleep. During the paralytic attacks, the infant may have abnormal body movements like different posturing, gait or imbalance problems. A few children also have seizures at the same time as the paralysis. Alternate hemiplegia varies in degree of severity from child to child. Some infants have mild short lived episodes whereas others have a severe form of paralysis that usually lasts a long time. In severe cases, the disorder is also associated with delayed mental development. During the episode, infants may become helpless. Those who develop facial paralysis may have difficutly swallowing or chewing food.
The cause of alternate hemiplegia is a mystery. No lesion has ever been identified using radiological studies of the brain. Research on this disorder reveals that some nerves in the brain start to get activated spontaneoulsy and this results in alternate hemiplegia. The majority of infants with this disorder have no family history but they are a few infants in whom this disorder runs in families. A specific gene has been identified in certain infants who develop hemiplegia. Unfortunately, most infants who develop the disorder do not have presence of this abnormal gene.

The symptoms of alternate hemiplegia are variable. The spasticity may appear on one or both legs. Subsequent episodes may involve the face or only arms. In severe cases, one may also develop balance problems, excess sweating, loss of bladder and bowel control, changes in body temperature and blurred vision. Because the condition spontaneously resolves, not every infant needs treatment. The spasticity is usually treated with a drug which acts like an anti spasmodic and helps to reduce severity and duration of attacks. The drug flunarizine is usually given to infant with the severe form of the disorder. Besides the drug, supportive care should be provided to the infant to ensure that he/she does not swallow food or saliva into the lungs. Many infants also are unable to control their bowel or bladder and thus good perineum care is required.
In most children with mild episodes of alternate hemiplegia the prognosis is good. However, those who experience severe form of alternate hemiplegia also tend to have poor mental functioning. These infants generally do not respond to the drug and continue to have problems with walking and decline mentally. Most infants with severe alternate hemiplegia become wheel chair bound or bed ridden.