Cherian et al. (1998) reported two cases that presented with features of alternating hemiplegia, neither of which had any family history of such a condition. The first case was a 19-month-old female born to non-consanguineous parents, who presented with the symptoms at the age of 20 days. Her mental and motor milestones were normal. Clinically, she was not dysmorphic, with no neurocutaneous markers, organomegaly, or neurological deficit in between the attacks. All investigations, which included renal and liver function tests, hematological tests (hemoglobin electrophoresis, Protein C, Protein S and antithrombin III levels), autoantibody profile, aminoacidogram, lactate levels, and CT scan of the brain were normal. An EEG revealed slowing during an episode of weakness. The patient did not respond to trials of various antiepileptic drugs. However, an improvement which included decrease in the frequency of the attacks along with shortening of the duration was noticed when the antiepileptic drugs were discontinued, and the patient was started on calcium channel blocker. She was followed up in the outpatient clinic and had no side effects of the drug. The second case was a 30-month-old male, who presented with three paroxysmal alternating episodes of acute onset weakness involving the upper limbs with spontaneous resolution within two to three hours. The clinical picture was similar to the first case but with less frequent attacks. Examination and investigations including EEG were all normal. The child was on regular follow up and was not put on any medications.

[Cherian EV, Alexander PC, Koul RL. Alternating hemiplegia of childhood, a report of two cases. Oman Med J. 1998; 14(3):57-9.]