Hypokalemic Periodic Paralysis - A rare channelopathy characterized by muscle weakness or paralysis with a matching fall in potassium levels in the blood. In individuals with this mutation, attacks often begin in adolescence and are triggered by strenuous exercise followed by rest, high carbohydrate meals, meals with high sodium content, sudden changes in temperature, and even excitement, noise or flashing lights. Weakness may be mild and limited to certain muscle groups, or more severe full body paralysis. Attacks may last for a few hours or persist for several days. Recovery is usually sudden when it occurs, due to release of potassium from swollen muscles as they recover. Some patients may fall into an abortive attack or develop chronic muscle weakness later in life. Some people only develop symptoms of periodic paralysis due to hyperthyroidism (over-active thyroid). This entity is distinguished with thyroid function tests, and the diagnosis is instead called thyrotoxic periodic paralysis.
"Known for her poetry, letters, love affair and marriage to Robert Browning, Elizabeth Barrett Browning also left a legacy of unanswered questions about her lifelong chronic illness."
Known for her poetry, letters, love affair and marriage to Robert Browning, Elizabeth Barrett Browning also left a legacy of unanswered questions about her lifelong chronic illness. Now, a Penn State anthropologist, with the aid of her daughter, may have unraveled the mystery.
Born in 1806, Barrett Browning suffered throughout her life from incapacitating weakness, heart palpitations, intense response to heat and cold, intense response to illnesses as mild as a cold, and general exhaustion in bouts that lasted from days to months or years. Her doctors were unable to diagnose or treat her illness, which apparently first appeared around age 13.
"Conjectures by modern biographers about Barrett Browning's condition include anorexia nervosa, neurasthenia; tuberculosis; pertussis, an encephalomyelitis; non-paralytic poliomyelitis; paralytic scoliosis, or the lifetime effects of injuries to her spine from falling from her horse in early adolescence; opium addiction; and mental illness, including anxiety and agoraphobia," Anne Buchanan, research associate in anthropology, reports in the current issue of Perspectives in Biology and Medicine.
Some even attribute her illness to defense against the inferior status and treatment of Victorian women, or simply to malingering.
Ellen Buchanan Weiss, Buchanan's daughter, noted the symptoms recorded in Barrett Browning's letters because the symptoms seemed so similar to those that she experienced. Buchanan Weiss has hypokalemic periodic paralysis (HKPP), a muscle disorder that causes blood levels of potassium to fall because potassium becomes trapped in muscle cells. The disorder was first described in 1874 in German and then in 1901 in English. Barrett Browning died in 1861, long before physicians would have any idea of HKPP.
Today, oral or intravenous potassium can prevent or stop an attack, but there is no cure for the disorder, which may be genetic, either inherited or caused by a sporadic mutation. According to Buchanan, there is slight evidence of an uncle in Barrett Browning's family who may have suffered the same symptoms. While Elizabeth and Robert did have a son, he apparently had no offspring so there are no living descendants.
A variety of triggers can initiate weakness for people with a periodic paralysis, says Buchanan.
Common triggers for people with HKPP include anything that increases secretion of insulin - alcohol, hunger or high carbohydrate foods - table salt, excessive heat or cold, sudden temperature change, illness, sleep, exercise or some medications. Symptoms of HKPP generally first appear at puberty.
Barrett Browning's first bout occurred after a minor illness, which was followed by measles. Her health continued to decline, and although physicians were unable to diagnose her malady, one prescribed opium to which she became addicted for life. This illness lasted for more than a year and at times she was so weak she could not sit upright without support.
Barrett Browning writes in the diary that she kept during her 25th year of other triggers for her ailment. She notes becoming weak after eating a generous portion of honey, a substance that would increase insulin production. She reports an episode that followed an outing where she ran down a hill, was rained upon and thoroughly soaked.Throughout her life, she suffered terribly during the cold damp winters in England, especially in London, and only found some relief after marrying Robert Browning and escaping to the warmer, milder climate of Italy.
Other incidents in her life that she recorded include suffering terribly after a day of religious fasting. Hunger is a strong HKPP trigger. Her letters to Browning, her 25th year diary and other letters to friends and relatives describe not only the symptoms of her disease, which mirror those of HKPP suffers and Buchanan Weiss specifically, but also a list of triggers that are now known to be specific triggers for HKPP.
After two years of declining health, Barrett Browning died on June 29, 1861, in Browning's arms.
Buchanan notes that "many others have read these same descriptions, looking for clues to her illness, but my daughter's experience with HKPP has given us a perhaps unique lens through which to view them."
Elizabeth Barrett Browning - (6 March 1806 - 29 June 1861) was one of the most prominent poets of the Victorian era. Her poetry was widely popular in both England and the United States during her lifetime. A collection of her last poems was published by her husband, Robert Browning, shortly after her death.
Elizabeth Barrett Browning Works (collections)
1820: The Battle of Marathon: A Poem. Privately printed
1826: A Essay On Mind, with Other Poems. London: James Duncan
1833: Prometheus Bound, Translated from the Greek of Aeschylus,and Miscellaneous Poems. London: A.J. Valpy
1838: The Seraphim, and Other Poems. London: Saunders and Otley
1844: Poems (UK) / A Drama of Exile, and other Poems (US). London: Edward Moxon. New York: Henry G. Langley
1850: Poems ("New Edition", 2 vols.) Revision of 1844 edition adding Sonnets from the Portuguese and others. London: Chapman & Hall
1851: Casa Guidi Windows. London: Chapman & Hall
1853: Poems (3d ed.). London: Chapman & Hall
1854: Two Poems: "A Plea for the Ragged Schools of London" and "The Twins". London: Bradbury & Evans
1856: Poems (4th ed.). London: Chapman & Hall
1857: Aurora Leigh. London: Chapman and Hall
1860: Poems Before Congress. London: Chapman & Hall
1862: Last Poems. London: Chapman & Hall
Posthumous publications of Barrett Browning's works
1863: The Greek Christian Poets and the English Poets. London: Chapman & Hall
1877: The Earlier Poems of Elizabeth Barrett Browning, 1826-1833, ed. Richard Herne Shepherd. London: Bartholomew Robson
1877: Letters of Elizabeth Barrett Browning Addressed to Richard Hengist Horne, with comments on contemporaries, 2 vols., ed. S.R.T. Mayer. London: Richard Bentley & Son
1897: Letters of Elizabeth Barrett Browning, 2 vols., ed. Frederic G. Kenyon. London:Smith, Elder,& Co.
1899: Letters of Robert Browning and Elizabeth Barrett Barrett 1845-1846, 2 vol., ed Robert W. Barrett Browning. London: Smith, Elder & Co.
1914: New Poems by Robert Browning and Elizabeth Barrett Browning, ed. Frederic G Kenyon. London: Smith, Elder & Co.
1929: Elizabeth Barrett Browning: Letters to Her Sister, 1846-1859, ed. Leonard Huxley. London: John Murray
1935: Twenty-Two Unpublished Letters of Elizabeth Barrett Browning and Robert Browning to Henrietta and Arabella Moulton Barrett. New York: United Feature Syndicate
1939: Letters from Elizabeth Barrett to B.R. Haydon, ed. Martha Hale Shackford. New York: Oxford University Press
1954: Elizabeth Barrett to Miss Mitford, ed. Betty Miller. London: John Murry
1955: Unpublished Letters of Elizabeth Barrett Browning to Hugh Stuart Boyd, ed. Barbara P. McCarthy. New Heaven, Conn.: Yale University Press
1958: Letters of the Brownings to George Barrett, ed. Paul Landis with Ronald E. Freeman. Urbana: University of Illinois Press
1974: Elizabeth Barrett Browning's Letters to Mrs. David Ogilvy, 1849-1861, ed. P. Heydon and P. Kelley. New York: Quadrangle, New York Times Book Co., and Browning Institute
1984: The Brownings' Correspondence, ed. Phillip Kelley, Ronald Hudson, and Scott Lewis. Winfield, Kans.: Wedgestone Press
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