Alternating Hemiplegia Of Childhood: Causes, Symptoms, and Treatment
Medically reviewed by Sumiran Racherla, MD, Internal Medicine. Last reviewed: October 23, 2026.
What kind of doctor treats Alternating Hemiplegia Of Childhood?
A pediatric neurologist (a children's doctor for brain and nerve problems) usually treats this condition. A geneticist (a doctor for inherited conditions) often helps confirm it. A direct primary care or concierge doctor can be a first stop for an evaluation and can refer you to a specialist when needed.
What is alternating hemiplegia of childhood?
Alternating hemiplegia of childhood is a rare brain and nerve condition. A child has repeated episodes where one side of the body becomes weak or paralyzed. Sometimes the weak side switches, or both sides are weak at once. The episodes usually start before 18 months of age.
During an episode, the weakness can last from minutes to days. A key sign is that all symptoms go away while the child sleeps. They can come back soon after the child wakes up.
Symptoms
Besides weakness, a child can have sudden attacks of uncontrolled muscle activity. Signs include:
- Involuntary limb movements, called choreoathetosis, or muscle tensing, called dystonia.
- Jerky eye movements, called nystagmus, or shortness of breath.
- Sudden flushing, meaning red and warm skin, or pallor, meaning pale skin.
- Seizures. By early childhood, more than half of children with the condition have seizures.
- Developmental delay. Almost all affected children have some delay and intellectual disability.
- Behavior changes, like outbursts, impulsivity, aggression, or mood problems.
Stress, extreme tiredness, cold temperatures, or bathing can trigger episodes. The trigger is not always known.
Causes and who gets it
The condition comes from a change in the ATP1A3 gene. This gene gives instructions for part of a pump that moves sodium and potassium into and out of nerve cells. The pump helps nerve cells signal muscles to move. With the gene change, the pump does not work well. Doctors are still learning how this causes the episodes.
The gene change is usually new, so most children have no family history. It can also run in families. Then one copy of the changed gene is enough to cause it, and half of that parent's children could inherit it. The condition is very rare. It affects about 1 in 1 million people.
How doctors diagnose it
Doctors look for key signs. These are episodes of weakness that switch sides and stop during sleep. A genetic test can find a change in the ATP1A3 gene and confirm the diagnosis. Many children also see a team of specialists during the workup.
Treatment
There is no cure. Treatment focuses on easing symptoms, keeping function, and preventing problems. Care is usually led by a team of specialists. Options include:
- Flunarizine. Doctors use this medicine to make episodes happen less often and less severely. Never stop it suddenly. Stopping it abruptly has been linked to getting worse. Follow your doctor's instructions.
- Rescue medicine for attacks. Doctors use benzodiazepines as rescue drugs during attacks.
- Seizure care. A neurologist treats seizures with standard seizure medicines. Ask for a seizure care plan with rescue therapy for long seizures.
- Therapies. Physical therapy and occupational therapy help with movement, stretching, and daily skills. Speech-language therapy helps with speech and swallowing.
- Avoiding triggers. When you can, avoid things like stress, missed meals, lack of sleep, bright light, heat or cold, and crowds.
For muscle stiffness, some medicines can help, but they can cause sleepiness and mood changes. Watch closely for side effects with the care team.
When to see a doctor
Call 911 right away if a child has trouble breathing during an episode or a seizure that does not stop. Get care right away if episodes suddenly get worse or a new sign appears. Keep regular visits with the care team so problems are found early.
How a direct primary care or concierge doctor fits in
A direct primary care doctor charges a flat monthly fee instead of billing insurance, while a concierge doctor usually charges more and often works alongside insurance. Your doctor can watch growth and development and handle common childhood illnesses. They can also help coordinate the specialists involved in long-term care.
Common questions
Is alternating hemiplegia of childhood inherited?
It is usually caused by a new gene change, so most children have no family history. When it runs in families, one copy of the changed gene is enough to cause it. A genetic counselor can help a family understand the pattern.
Do the episodes happen during sleep?
No. A key sign of the condition is that all symptoms go away while the child sleeps. They can come back shortly after the child wakes up.
What can trigger an episode?
Stress, extreme tiredness, cold temperatures, or bathing can trigger episodes. The trigger is not always known. Avoiding known triggers can help lower how often episodes happen.
Is there a cure?
There is no cure for the condition. Treatment focuses on easing symptoms, keeping function, and preventing problems. A team of specialists usually guides the care.
Sources
- MedlinePlus Genetics - Alternating hemiplegia of childhood
- NCBI Bookshelf - ATP1A3-Related Disorder (GeneReviews)
- NIH Genetic and Rare Diseases Information Center - Alternating hemiplegia of childhood
Medical Disclaimer
This content is for general educational and informational purposes only and is not medical advice. It is not a substitute for professional medical advice, diagnosis, or treatment, and reading it does not create a doctor-patient relationship. Always seek the advice of your physician or another qualified health provider with any questions about a medical condition, and never disregard or delay seeking professional advice because of something you read here. If you think you may have a medical emergency, call 911 (or your local emergency number) immediately.
