27 June 2020
ANOTHER GREAT STUDY ABOUT BEHAVIORAL PROBLEMS IN AHC PUBLISHED BY THE DUKE GROUP
In the article (Wallace K, Uchitel J, Prange L, Jasien J, Bonner M, D'Alli R, Maslow G, Mikati MA. Characterization of Severe and Extreme Behavioral Problems in Patients with Alternating Hemiplegia of Childhood. Paediatr Neurol. 2020 Jun 27. doi: 10.1016/j.pediatrneurol.2020.06.012) published by the group of the AHC Clinic at the Duke University Medical Center, directed by Professor Mohamad Mikati, they analyzed 39 consecutive AHC patients for occurrence of behavioral problems.
- Six (15%) patients had extreme problems defined as those present in major risk of injury to themselves or to others
- Ten (26%) had severe problems which presented minor risk of injury to themselves or to others
- Five (13%) had moderate problems defined as requiring intervention but presenting no risks of injury
- Two (5%) had mild problems defined as not requiring interventions
- Sixteen (41%) had no behavior problems
Triggers noted in many patients
- low frustration tolerance
- limits set by others
- sleep disruption
- Some medications
Reversible psychotic symptoms occurred in 2 of the 39 patients
- In one, the trigger was trihexyphenidyl
- In the above patient infection was a trigger on another occasion
- In another patient, the trigger was the medication sertraline.
- Diagnosis and therapy of coexisting neuropsychiatric diagnoses like anxiety, depression or attention deficit disorder
- Involvement of a multidisciplinary team including mental-health professionals neurology and developmental Pediatrics
- Medications targeting the patient’s specific problem and coexisting neuropsychiatric diagnosis and that often alpha-adrenergic agonists and SSRIs.
- Forty one percent of AHC patients often experience severe/extreme behavioral problems
- On rare occasions, AHC patient may have medication-triggered psychotic symptoms.
- These correlate with the known AHC brain pathophysiology.
- Awareness of these behavioral problems should allow anticipatory guidance and better management of such problems when they occur in some AHC patients
You can read the article at this link