The Role of Nutrition and Physical Activity as Trigger Factors of Paralytic Attacks in Primary Periodic Paralysis

Abstract

Background: Primary periodic paralysis (PPP) are rare inherited neuromuscular disorders including Hypokalemic periodic paralysis (HypoPP), Hyperkalemic periodic paralysis (HyperPP) and Andersen-Tawil syndrome (ATS) characterised by attacks of weakness or paralysis of skeletal muscles. Limited effective pharmacological treatments are available, and avoidance of lifestyle related triggers seems important. Objective: Our aim was to search and assess the scientific literature for information on trigger factors related to nutrition and physical activity in PPP. Methods: We searched Ovid Medline and Embase database for scientific papers published between January 1, 1990, to January 31, 2020. Results: We did not identify published observation or intervention studies evaluating effect of lifestyle changes on attacks. Current knowledge is based on case-reports, expert opinions, and retrospective case studies with inadequate methods for description of nutrition and physical activity. In HypoPP, high carbohydrate and salt intake, over-eating, alcohol, dehydration, hard physical activity, and rest after exercise are frequently reported triggers. Regarding HyperPP, fasting, intake of potassium, alcohol, cold foods or beverages, physical activity, and rest after exercise are frequently reported triggers. No nutrition related triggers are reported regarding ATS, exercise can however induce ventricular arrhythmias. Conclusions: Our results support that dietary intake and physical activity may play a role in causing paralytic attacks in PPP, although the current scientific evidence is weak. To provide good evidence-based patient care, several lifestyle aspects need to be further assessed and described.

Intricacies in Managing Hypokalemic Periodic Paralysis in Afghanistan: A Case Report

“…HPP is reported to be triggered by factors including high intake of carbohydrates and salt, overeating, alcohol consumption, dehydration, surgery, pregnancy, sudden changes in temperature, strenuous exercise, and rest following such activities. 6 Our patient, as well, experienced a similar episode after a football game and a full meal. Clinicians, therefore, must emphasize to patients the importance of recognizing and avoiding such triggers to prevent paralytic episodes.…”

“…Additional triggers encompass exposure to cold, stress, excitement, fear, prolonged immobility, glucocorticoid use, and anesthetic procedures. 5,6 Despite its rarity, sensory functions usually remain normal; 5 thus, it is essential to distinguish periodic paralysis from other causes of weakness and paralysis to initiate the correct treatment promptly. However, in certain parts of the world, such as Afghanistan, healthcare resources are markedly limited, resulting in insufficient information and inadequate management of HPP.…”

Acute flaccid paralysis in Indonesian adult due to suspected familial hypokalemia paralysis: A rare case

“…In hypokalemia with hypomagnesemia, correction of Mg2+ deficiency should be performed concurrently. The deficit should be corrected gradually over 24–48 hours with regular monitoring of plasma K+ concentrations to avoid transient overrepletion and transient hyperkalemia [ 3 , 12 ]. Effective management of hypokalemic is used to reduce mortality in hypokalemic patients, of which 20% of hypokalemic patients die [ 13 ].…”

Reccurent Thyrotoxic Hypokalemic Periodic Paralysis: Laporan Kasus

“…THPP terjadi terutama pada waktu istirahat, biasanya pada malam hari, dapat memburuk dengan aktivitas fisik, makanan tinggi karbohidrat, olahraga, dan stres (Welland et al, 2021). Kelemahan lebih sering muncul pada ekstremitas bawah dan lebih jarang pada ekstremitas atas.…”