The condition is believed to be due to immaturity of the sleep-arousal system in the brain. There is no treatment (except to guide the sleepwalker back to bed). Above all, the patient must be protected against injury from walking into obstacles or falling down stairs. Most patients outgrow the affliction.
Q: My wife suffered a mini-stroke three years ago, followed shortly by a distended liver. A year ago, she was diagnosed with polycythemia vera. Can you give us some understanding of this disease and what her long-range prospects are?
A: Your wife's health problems are probably related. Polycythemia vera is a blood disease characterized by too many red blood cells. Other blood cells (notably platelets) are frequently present in excess quantities, too. These additional cells cause the blood to thicken. As the viscosity increases, secondary effects appear, including liver enlargement, headache, peptic ulcer, bone pain, fatigue, visual disturbances and a tendency for the blood to clot too quickly.
Since strokes (whether permanent or temporary) are usually caused by small blood clots that lodge in the brain, patients with polycythemia are prone to this complication. Therefore, I believe that your wife's mini-strokes and enlarged liver are the direct consequences of her underlying blood disorder.
The safest and easiest treatment (and the one that gives the most prompt benefit) is phlebotomy. Doctors remove a pint of blood every two days until the hematocrit (a measure of the percentage of cells in the bloodstream) falls below 45 percent, the normal value. Thereafter, the patient is bled at periodic intervals to maintain the proper balance of cells and fluid in the blood.
In addition, once the blood count returns to normal, alternative therapy can be considered: either radioactive phosphorus or hydroxyurea will reduce the speed with which new blood cells are formed.
Untreated polycythemia carries a 50 percent mortality rate within 18 months of diagnosis. Thus, future prospects are bleak unless your wife obtains appropriate therapy. With treatment and close medical follow-up, her polycythemia can be controlled for many years. In my opinion, patients with this disorder should be under the care of hematologists.
Dr. Peter Gott will answer readers' questions in his column. Send your question to Dr. Gott, care of the Philadelphia Daily News, 400 N. Broad St., Phila., Pa. 19130.