We report here the efficacy of amantadine hydrochloride for two patients with alternating hemiplegia of childhood (AHC) that did not respond to flunarizine. Amantadine was administered to one patient at age one year and seven months and to the other at age 25 years. The frequencies and duration of the hemiplegic attacks significantly improved in both patients. However, the attacks gradually returned to the previous level after a significant reduction in seizures for three years in the younger patient with ongoing AHC. Our therapeutic results further support the hypothesis that glutamate and NMDA receptors are involved in inducing alternating hemiplegic attacks, because amantadine as well as its derivative, memantine, are clinically available non-competitive N-methyl-D-aspartate (NMDA) receptor antagonists, with neuroprotective effects. Amantadine is worth trying when treating patients with AHC as a first trial or a substitute for flunarizine once the latter agent looses effect.
Key words
Amantadine - Memantine - Alternating hemiplegia - Non-competitive NMDA receptor antagonist
References
-
1 Aicardi J, Bourgeois M, Goutières F. Alternating hemiplegia of childhood: Clinical findings and diagnostic criteria. Andermann F, Aicardi J, Vigevano F Alternating Hemiplegia of Childhood. New York; Raven Press 1995: 3-18
-
2
Arnold D L, Silver K, Andermann F.
Evidence for mitochondrial dysfunction in patients with alternating hemiplegia of childhood.
Ann Neurol.
1993;
33
604-607
-
3 Bourgeois M, Nevsimalova S, Aicardi J, Andermann F. Alternating hemiplegia of childhood: long-term outcome. Andermann F, Aicardi J, Vigevano F Alternating Hemiplegia of Childhood. New York; Raven Press 1995: 49-54
-
4
Casaer P.
Flunarizine in alternating hemiplegia in childhood. An international study in 12 children.
Neuropediatrics.
1987;
18
191-195
-
5
Korinthenberg R.
Is infantile alternating hemiplegia mediated by glutamate toxicity and can it be treated with memantine?.
Neuropediatrics.
1996;
27
277-278
-
6
Parsons C G, Danysz W, Quack G.
Memantine is a clinically well tolerated N-methyl-D-aspartate (NMDA) receptor antagonist - a review of preclinical data.
Neuropharmacology.
1999;
38
735-767
-
7
Rho J M, Chugani H T.
Alternating hemiplegia of childhood: insights into its pathophysiology.
J Child Neurol.
1998;
13
39-45
-
8
Sakuragawa N.
Alternating hemiplegia in childhood; 23 cases in Japan.
Brain Dev.
1992;
14
283-288
-
9
Siemes H.
Rectal chloral hydrate for alternating hemiplegia of childhood.
Dev Med Child Neurol.
1990;
32
931
-
10
Silver K, Andermann F.
Alternating hemiplegia of childhood: a study of 10 patients and results of flunarizine treatment.
Neurology.
1993;
43
36-41
-
11
Veneselli E, Biancheri R.
Alternating hemiplegia of childhood: treatment of attacks with chloral hydrate and niaprazine.
Eur J Pediatr.
1997;
156
157-158
-
12
Verret S, Steele J C.
Alternating hemiplegia in childhood: a report of eight patients with complicated migraine beginning in infancy.
Pediatrics.
1971;
47
675-680
M. D. Hirokazu Oguni
Department of Pediatrics
Tokyo Women's Medical University
8-1 Kawada-cho, Shinjuku-ku
Tokyo 162
Japan
eMail: hoguni@ped.twmu.ac.jp
