ALTERNATING HEMIPLEGIA IN CHILDHOOD: A REPORT OF EIGHT PATIENTS WITH COMPLICATED MIGRAINE BEGINNING IN INFANCY

Abstract

In this report eight patients are described who suffer an unusual symptom complex of intermittent, alternating hemiplegia. Symptoms have begun in early childhood and in one child at age 3 months. Typically, there is a brief vasomotor prodrome and then the abrupt onset of hemiplegia. Contralateral headache tends to develop soon after the onset of neurological symptoms. Recovery is usual within several hours but may be prolonged over several days. Recurrence during early childhood is frequent. Serial electroencephalograms have shown fluctuating and inconstant slow wave abnormalities as occur with cerebral ischaemia, but radiological investigations have failed to indicate structural or dynamic changes in cerebral blood vessels. The treatment of the disorder is symptomatic and antiserotonin compounds have not been found to be effective. As these children have matured, attacks have become less frequent and in some a more characteristic picture of migraine has emerged. In several patients residual neurological signs including dementia and dyskinesia are now present. Because convulsions occasionally occur with the hemiplegia, differentiation from a primary seizure disorder is often difficult. The profile and evolution of symptoms, however, suggests that these patients suffer a primary vascular disorder within the category of migraine, but they are unusual in the early onset of symptoms and the fixed neurological deficits that may ensue.