[Alternating hemiplegia of childhood treated as epilepsy. Two new cases]. / Hemiplejía alternante de la infancia tratada como epilepsia. Dos nuevos casos.

INTRODUCTION: Alternating hemiplegia (AH) of childhood is a rare disease that gives rise to transient attacks of hemiplegia that may affect either side of the body indistinctly, or even both sides at the same time. Onset occurs before the age of 18 months and in some cases there are neonatal symptoms such as abnormal eye movements, especially nystagmus, and dystonic or tonic seizures. Attacks of hemiplegia, which disappear during sleep, begin before the age of one year. These symptoms can initially be taken for an epileptic disorder. CASE REPORTS: We describe the study of two male patients whose clinical symptoms appeared at the age of 6 months, with tonic seizures, upward deviation of gaze, without loss of consciousness, which occurred with a recurrence rate of between one and two attacks a week or several times a day. They were initially treated with antiepileptic drugs (AED), although the complementary tests, including electroencephalogram (EEG), computerised axial tomography (TAC), magnetic resonance (MR) scans and metabolic tests, were all normal. CONCLUSIONS: Since, to date, no specific test has been confirmed for the disease, diagnosis is essentially clinical and by exclusion. Treatment is symptomatic using flunarizine. In one of our cases, administration of a single 10 mg/day dose this drug at night lowered the frequency of the attacks of hemiplegia. The possibility of treating a patient who is a carrier of an AH with AED makes early knowledge and identification of this disease necessary in order to be able to improve the patient's prognosis.

Hemiplejía alternante de la infancia tratada como epilepsia. Dos nuevos casos / Alternating hemiplegia of childhood treated as epilepsy. Two new cases

Introducción. La hemiplejía alternante (HA) de la infancia es una enfermedad poco frecuente. Provoca crisis de hemiplejía transitorias que pueden afectar indistintamente a uno u otro hemicuerpo, e incluso a ambos a un mismo tiempo. Se inicia antes de los 18 meses y, en algunos casos, se presentan síntomas neonatales, como movimientos anormales oculares, sobre todo nistagmo, y crisis distónicas o tónicas. Antes del año de edad se inician los ataques hemipléjicos, que desaparecen con el sueño. Estos síntomas pueden llevar a una confusión inicial con un trastorno epiléptico. Casos clínicos. La observación de dos pacientes varones cuyas manifestaciones clínicas aparecieron a los 6 meses de edad con crisis tónicas, con desviación hacia arriba de la mirada y sin pérdida de la conciencia, que se producían con una periodicidad recurrente variable de una a dos crisis por semana o varias al día. Se trataron inicialmente con fármacos antiepilépticos (FAE), aunque las pruebas complementarias, entre ellas el electroencefalograma (EEG), la tomografía axial computarizada (TAC), la resonancia magnética (RM), y las pruebas metabólicas eran normales. Conclusiones. Ya que no se ha demostrado hasta la actualidad un examen específico de la enfermedad, el diagnóstico es fundamentalmente clínico y por exclusión. El tratamiento es sintomático con flunaricina. En uno de nuestros casos, una dosis de 10 mg/día única nocturna produjo una disminución en la frecuencia y la intensidad de los ataques hemipléjicos. La posibilidad de tratar a un paciente portador de una HA con FAE hace necesario el conocimiento y la identificación precoz de esta enfermedad, con el fin de mejorar su pronóstico

Introduction. Alternating hemiplegia (AH) of childhood is a rare disease that gives rise to transient attacks of hemiplegia that may affect either side of the body indistinctly, or even both sides at the same time. Onset occurs before the age of 18 months and in some cases there are neonatal symptoms such as abnormal eye movements, especially nystagmus, and dystonic or tonic seizures. Attacks of hemiplegia, which disappear during sleep, begin before the age of one year. These symptoms can initially be taken for an epileptic disorder. Case reports. We describe the study of two male patients whose clinical symptoms appeared at the age of 6 months, with tonic seizures, upward deviation of gaze, without loss of consciousness, which occurred with a recurrence rate of between one and two attacks a week or several times a day. They were initially treated with antiepileptic drugs (AED), although the complementary tests, including electroencephalogram (EEG), computerised axial tomography (TAC), magnetic resonance (MR) scans and metabolic tests, were all normal. Conclusions. Since, to date, no specific test has been confirmed for the disease, diagnosis is essentially clinical and by exclusion. Treatment is symptomatic using flunarizine. In one of our cases, administration of a single 10 mg/day dose this drug at night lowered the frequency of the attacks of hemiplegia. The possibility of treating a patient who is a carrier of an AH with AED makes early knowledge and identification of this disease necessary in order to be able to improve the patient’s prognosis