Presentation
The variability of individual clinical presentations and evolution of symptoms have made diagnosis difficult. Therefore the problems of misdiagnosis could account for the low prevalence of this syndrome. [ncbi.nlm.nih.gov]
Lifetime information allowed us to investigate whether a sign/symptom was present previously, even if it was no longer present at the time of inclusion or at 6–12 years old. [ojrd.biomedcentral.com]
Entire Body System
- Icelandic Families
Englot Neurosurgical Review (2018) COPA syndrome in an Icelandic family caused by a recurrent missense mutation in COPA Brynjar O. Jensson, Sif Hansdottir, Gudny A. Arnadottir, Gerald Sulem, Ragnar P. [doi.org]
- Slender Habitus
On physical ground, almost all patients shared a similar physical phenotype consisting of hypotonia, long face, thin eyebrows, strabismus, hypertelorism, long palpebral fissures, downturned mouth, and slender habitus. [ncbi.nlm.nih.gov]
- Wheelchair Bound
At an age between 6 and 12 years old, nearly half of them walked only with assistance and one third were wheelchair-bound ( p = 0.039). [ojrd.biomedcentral.com]
Skin
- Thin Eyebrows
On physical ground, almost all patients shared a similar physical phenotype consisting of hypotonia, long face, thin eyebrows, strabismus, hypertelorism, long palpebral fissures, downturned mouth, and slender habitus. [ncbi.nlm.nih.gov]
Neurologic
- Clonus
At that time, mild increased tone was found, tendon reflexes were 3+ throughout, and a right extensor plantar response and a bilateral achilleus clonus were present. [doi.org]
- Psychomotor Regression
The first was dominated by abnormal eye movements and dystonic episodes, the second by hemiplegic spells and psychomotor regression, and the third by persistent developmental delay and fixed neurologic deficits. [ncbi.nlm.nih.gov]
Workup
Characteristics of disease onset, medical comorbidities, episode triggers, diagnostic workup, and treatment are presented. Paroxysmal eye movements were the most frequent early symptom, manifesting in the first 3 months of life in 83% of patients. [ncbi.nlm.nih.gov]
Characteristics of disease onset, medical comorbidities, episode triggers, diagnostic workup, and treatment are presented. RESULTS. [doi.org]
Gastroenterologic evaluation and workup typically yield unremarkable results. [48] Abdominal migraine symptoms are usually relieved with sleep. Antiemetics may help in aborting an acute attack. [emedicine.com]
Blocks
- Incomplete Right Bundle Branch Block
Over half the affected cohort (28/52) had intraventricular conduction delay, or incomplete right bundle branch block, a much higher proportion than in the normal population or disease control cohort (P = 0.0164). [ncbi.nlm.nih.gov]
T Wave
- T Wave Abnormality
Half the cohort (26/52) had resting 12-lead electrocardiogram abnormalities: 25/26 had repolarization (T wave) abnormalities. [ncbi.nlm.nih.gov]
Treatment
A comparison of the pharmacological actions of successful and unsuccessful treatments for AHC is made. [ncbi.nlm.nih.gov]
Mikati, Diagnosis and Treatment of Alternating Hemiplegia of Childhood, Current Treatment Options in Neurology, 10.1007/s11940-017-0444-7, 19, 2, (2017). [doi.org]
Prognosis
Making an early diagnosis can help to describe to the parents the good prognosis without treatment. [ncbi.nlm.nih.gov]
Prognosis The classic form of alternating hemiplegia has a poor prognosis, with progressively severe impairment of mobility and cognitive functioning, requiring long-term care. [encyclopedia.com]
Etiology
Alternating hemiplegia of childhood is a predominantly sporadic neurodevelopmental syndrome of uncertain etiology. [ncbi.nlm.nih.gov]
Epidemiology
Summary Epidemiology Annual incidence is estimated at 0.9/100,000 newborns. Clinical description Onset occurs before 18 months of age. [orpha.net]
America. 11 Pacific Northwest Diabetes Research Institute, Seattle, Washington, United States of America. 12 Departments of Neuroscience and Pediatrics, University of California San Diego, San Diego, California, United States of America. 13 Department of Epidemiology [ncbi.nlm.nih.gov]
J Pediatr 122: 673–679 PubMed Google Scholar Breslau N, Davis GC (1992) Migraine, major depression and panic disorder: a prospective epidemiologic study of young adults. [doi.org]
Migraine: epidemiology, impact, and risk factors for progression. Headache. 2005 Apr. 45 Suppl 1:S3-S13. [Medline]. [Guideline] Headache Classification Subcommittee of the International Headache Society. [emedicine.com]
Pathophysiology
The pathophysiology of alternating hemiplegia of childhood (AHC) is unclear. The authors evaluated the skin and muscle biopsies from patients with AHC for vascular abnormalities. [ncbi.nlm.nih.gov]
Prevention
Amantadine as an alternative agent is used in add-on therapy, but epileptogenic side effect prevented the evaluation of long-term efficacy. [ncbi.nlm.nih.gov]
While avoiding these triggers may reduce the risk of an episode, it can also have a negative effect on family life, so a balance between prevention and normality needs to be reached after discussion with the team. [gosh.nhs.uk]
There are several drugs available for treatment, as well as management strategies for preventing and dealing with hemiplegic attacks. [en.wikipedia.org]
For long-term prevention, low doses of TCAs and flunarizine, a calcium channel blocker, are effective. [55] Other migraine-preventing medications are occasionally of some benefit. [emedicine.com]