Alternating Hemiplegia in a Child Misdiagnosed as Intractable Epilepsy Successfully Treated with Aripiprazole: A Case Report

BACKGROUND: Alternating hemiplegia of children is a rare neurological disorder that in its characteristic form has few differential diagnosis. The diagnosis of intractable seizures is difficult to avoid for physicians not aware of the disease. OBJECTIVE: To describe the clinical characteristics of Alternating Hemiplegia of Childhood (AHC), and response to various drugs METHODS: A Ghanaian child with AHC was followed up for three years at the Neurology Clinic, Korle Bu Teaching Hospital, Accra. Her characteristics including EEG and MRI findings were documented. She was severely unsuccessfully treated as an epileptic. Further clinical re-evaluation provided clues to the diagnosis of aaalternating hemiplegia of childhood. RESULTS: The child, a female patient, was seen within the first week of life. The initial complaints were abnormal eye movements, and subsequently recurrent hemiplegic episodes, that started at age two and lasted hours to days. Attacks occurred at a frequency of about three per month and lasted from several hours to three days. An established trigger was bathing with cold water. Sleep relieved symptoms. The child had evidence of global developmental delay and neurological abnormalities including ataxia. EEG and MRI were both reported as abnormal. She experienced recurrent seizures. Topiramate and several anti-convulsants were not helpful but aripiprazole reduced the frequency of attacks. CONCLUSION: The case highlights the fact that AHC starts very early in life and is commonly misdiagnosed as epilepsy .It can coexist with epilepsy and abnormal MRI findings. Aripiprazole appears effective in its treatment.