Elizabeth Barrett Browning Suffered with HKPP: Trapped Potassium

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Talk about a delayed diagnosis: 150 years after the death of Elizabeth Barrett Browning, a Penn State anthropologist has announced what appears to have been the chronic, debilitating illness that plagued the famous Victorian poet throughout most of her life. Known as HKPP, an acronym for hypokalemic periodic paralysis, it involves potassium trapped in the cells.

The mystery of Browning’s illness has plagued biographers

Anthropologist Anne Buchanan, a research associate in anthropology, arrived at the possible diagnosis of HKPP because her own daughter, Ellen Buchanan Weiss, has the illness, and Ellen pointed out the similarities between Barrett Browning’s symptoms and her own.

Barrett Browning experienced chronic symptoms that included incapacitating weakness, severe response to cold and heat, general fatigue, heart palpitations, and intense response to illnesses such as colds.

HKPP, which was first identified more than a decade after Barrett Browning’s death in 1861, is an inherited congenital (present from birth) disorder that causes muscle weakness and sometimes even severe paralysis. The condition occurs in about 1 in every 100,000 individuals.

Victims of HKPP have very low levels of potassium during their episodes of weakness, which is the result of the mineral moving from the blood into the muscle cells and becoming trapped. This sign confirms the diagnosis. Between bouts of intense weakness, affected individuals typically have normal muscle strength.

Attacks of muscle weakness usually begin during adolescence, and Barrett Browning reportedly first had symptoms when she was about 13 years old, following a minor illness, after which she developed measles. Even though no doctor was able to give her a diagnosis, one physician prescribed opium, to which the poet became addicted for the rest of her life.

Descriptions of symptoms revealed in the poet’s letters and details in her diary have served as fodder for modern biographers to speculate on Barrett Browning’s illness. Until now, some of the possible explanations have included anorexia nervosa, tuberculosis, paralytic scoliosis, pertussis, non-paralytic polio, and even opium addiction.

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Currently there is no cure for HKPP. Therapy includes oral or intravenous potassium, which can stop an attack. Conditions that can trigger an attack include anything that increases the secretion of insulin, such as hunger, excessive cold or heat, illness, eating high-carb foods, and use of alcohol.

In Barrett Browning’s case, her writings reveal many triggers, including the fact that she suffered extensively during cold weather and that she became weak after eating a great deal of honey—a food that can raise insulin production. She also had severe episodes after fasting (hunger as a trigger) for religious reasons.

The muscle weakness associated with HKPP typically affects the hips and shoulders, and there were occasions when Barrett Browning was so weak she could not sit upright without support. The weakness can also affects the arms, legs, muscles of the eyes, and muscles that assist with breathing and swallowing.

Today, HKPP is diagnosed by checking blood potassium levels during an attack of muscle weakness. Other tests can include an echocardiogram, which can detect heart abnormalities during attacks; an electromyogram, which checks the muscles and the nerves that control them; and a muscle biopsy.

While oral or intravenous potassium can stop attacks, potassium supplements will not prevent them. Drugs prescribed for prevention include acetazolamide, triamterene, and spironolactone. Complications of HKPP may include kidney stones (side effect of acetazolamide), heart arrhythmias during attacks, and progressive muscle weakness that can become permanent.

Buchanan noted that while many other researchers have scoured Elizabeth Barrett Browning’s writings to uncover clues to her malady, “my daughter’s experience with HKPP has given us a perhaps unique lens through which to view them.”

SOURCE:
Penn State University

Picture credit: Wikimedia Commons

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