Clinic Notes: Transiet hemiplegia and Alternating Hemiplegia of Childhood

Transient hemiplegia (one-sided paralysis) can be caused by low blood sugar in childhood diabetes and other organic conditions, such as transient ischemic attacks (TIA’s), and also some types of migraines. Like adults, children can have strokes with permanent paralysis. Sometimes the term transient hemiplegia refers to a rare condition known as Alternating Hemiplegia of Childhood. In this disorder, one side is paralyzed one day, and the other side is paralyzed on other days, which seems to defy basic neuroanatomy. The only minimally effective treatment reported for Alternating Hemiplegia of Childhood is a calcium channel blocker called Flunarizine. The FDA has not approved this drug, and since so few cases of Alternating Hemiplegia of Childhood exist, they are not likely to do so. Only 250 children worldwide are affected by this disorder so there’s a real shortage of patients for studies into the causes. Years ago, I saw a young child in my clinic with a diagnosis of Alternating Hemiplegia. I didn’t think it likely that such a rare disorder would pop up in my clinic and was suspicious of the diagnosis from the beginning. After several months it turned out to be a case exactly like Jamie’s. See http://www.rarediseases.org and The 2000 June-August issue of the online publication of Perspectives: A Mental Health Magazine at http://mentalhelp.net/perspectives/ for a brief account of this case.
Go to www.aba4autism.com for a complete case history in Little Bubba's Not Ready for Nashville.

Clinic notes: "The Longest Running Horror Movie."

David M. didn't have an appointment. I found him standing in my doorway one afternoon, his body trembling, a look of desperation on his face. After a few moments of silence, he sat down in the chair I pointed to across from my desk and began his history with a twenty-year flashback.
His father's car was parked beside a cemetery on a lonely country road. Of course, it was a dark and stormy night and a scream from the back seat "pierced the darkness."
"I know this sounds like the beginning to a second-rate horror movie," David conceded in a nervous voice. "But that's exactly what my life's been- -a second-rate horror movie."
For the rest of this case history go to http://www.aba4autism.com

Clinic Notes: Biting in Children

Recently my daughter called to tell me that my 14 month-old granddaughter had just bitten another child. Children age 13-24 months are bitten most often in day care centers and usually the biting is most likely to occur at the beginning of the school year. The arms and face of the child are the areas most frequently bitten, but only one bite in fifty actually breaks the skin. Occasionally, children get kicked out of day care for biting other children and staff.
More serious biting of others or one’s self is often seen in children with neuropsychological disorders like autism, Fragile X Syndrome, and mental retardation. In rare neuropsychological disorders, like Lesch-Nyham syndrome, children compulsively bite their lips, fingers and arms, and bite others as well. A variety of extreme measures, including teeth extraction have been used to try to control biting in this disorder. Physical restraints are te only effective remedy, and many Lesch-Nyham patients will ask to be placed in restraints when they feel a biting episode coming on.
See Case History # 6 in Little Bubba's Not Ready for Nashville Yet at http://www.aba4autism.com

Clinic Notes: Autism and Down Syndrome

I once had a set of twins coming to my clinic. One twin was developing normally, and the other twin had Down Syndrome and then developed Autism at the age of four four. Recent studies find that 7 to 10 percent of children with Down Syndrome also have Autism.
In 1959 the genetic basis of Down Syndrome was found to be trisomy 21 in 95 percent of the cases and the extra chromosome is usually maternal in origin. People with Down Syndrome are depicted in ancient art; so apparently the disorder has been around for a long time. In 1866 Dr. John Langdon Down wrote about the facial similarities of many of his patients with mental retardation using a racial description (Mongol), which unfortunately stayed around for nearly a century. Once the genetic basis of the disorder was known,the terminology changed and now the correct terminology is to refer to them as persons with trisomy 21 or a person with Down Syndrome. See http://www.nas.com/downsyn/trumble.html for a detailed discussion of Down Syndrome.
Women older than forty or mothers who already have a child with Down Syndrome are more likely to give birth to babies with Down Syndrome, and routinely undergo amniocentesis at sixteen weeks. Taking into account surgical and spontaneous abortions the incidence of Down’s is approximately one in every eight hundred births. Younger mothers who do not undergo amniocentesis deliver the majority of Down’s babies because they don’t get tested. A new test, which combines blood tests and an ultrasound, is 90 percent accurate in the first trimester and can be done four to six weeks earlier than the standard Triple Test.
Why some children with Down Syndrome develop autism and other do not is not known.
See Case History # 15 in Little Bubba's Not Ready for Nashville Yet at http://www.aba4autism.com