Efficacia del topiramato in un caso di emiplegia alternante: follow-up di 12 mesi.

We describe a 12-years-old white girl with a family history of migraine, displaying alternating hemiplegic attacks since the age of seven months. Neuroimaging, genetic, metabolic, cardiovascular and coagulation investigations turned out to be negative. An ictal video-EEG showed posterior slow waves. After failing conventional antiepileptic and antimigraine treatment, Topiramate was started in add-on with Valproate and Flunarizine, which induced a dramatic reduction of hemiplegic attacks. These results suggest the effectiveness of Topiramate in the treatment of alternating hemiplegia. Its possible mechanism of action is discussed.