Treatment Updates for Neuromuscular Channelopathies from NIH
Structure and function of voltage-gated sodium channels from NIH
Important:
Treatment of periodic paralysis involves both interventions to abort or ameliorate an acute attack of weakness as well as preventative strategies.
Diet and lifestyle
The strongest trigger of a paralytic attack in any form of periodic paralysis is excessive exercise followed by rest. The most important advice is therefore for patients to adhere to ‘warming-up’ as well as ‘warming-down’ with any type of exercise. If possible, activities should be scheduled earlier in the day and avoided before bedtime. Gentle exercise however, e.g. walking, can be utilised to abort an impending attack if the onset is recognised at an early stage. Other common triggers are alcohol, stress and lack of sleep, perhaps part of the reason why attacks tend to be more frequent during adolescent and young adulthood [10•, 83].
Diet is another modifiable trigger for many. Patients with HypoPP should avoid high carbohydrate loads, which stimulate insulin secretion, which in turn can drive serum potassium from the extra to the intracellular compartment and trigger muscle weakness. In contrast, patients with HyperPP should avoid potassium-rich diets and fasting. Carbohydrate-containing snacks can be beneficial in acute HyperPP attacks but are not recommended as a long-term treatment strategy. Diet advice for patients with ATS generally follows HypoPP advice. A food and lifestyle diary can be useful in patients with frequent attacks to identify triggers.
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