Cerebral Palsy and Periventricular Leukomalacia (PVL)
Damage to the white matter of the brain can cause cerebral palsy, and periventricular leukomalacia (PVL) is one of the primary reasons that children develop the disorder. Although there is no current treatment or cure for PVL, there are a number of therapy options to consider, and other forms of treatment for any associated medical problems that arise.
What is Periventricular Leukomalacia?
PVL is a form of brain damage that adversely affects the white matter of the infants’ brain. It can be caused during or shortly after birth, as well as while the baby is still in utero. Scientists who researched PVL speculate that it most often develops between 24-36 weeks gestation.
When damage occurs the white matter in the brain, the cells die, and in turn, holes and empty spaces are created in a part of the brain. The periventricular white matter sends nerve impulses that control motor function, and spasticity, cognitive impairment, and vision issues are often a result of PVL.
As mentioned earlier, infants with PVL are at a heightened risk of developing cerebral palsy. In fact, anywhere from 60% to 100% of all babies will PVL will also be diagnosed with cerebral palsy.
The name periventricular leukomalacia is derived from the medical terms:
- Periventricular: Around or near the ventricles
- Leuko: White
- Malacia: Softening
What Causes PVL?
The cause of PVL is still uncertain, but medical researchers have surmised that lack of oxygen or lack of blood flow to the periventricular area of the brain is the primary reasons the condition develops. Lack of oxygen and blood flow can occur when the infant isn’t delivered in time, such as when a physician fails to carry out an emergency C-section.
Babies born too early are at risk as well; premature infants born prior to 32 weeks gestation are especially susceptible to PVL. Maternal infections and rupture of the amniotic sac are other cause that can possibly lead to PVL.
Other causes can include:
- Using drugs while pregnant
- Failure of physicians to perform an emergency C-section
- Umbilical cord inflammation
- Antepartum hemorrhage
- Carrying twins
- Fetal membrane inflammation
Each baby’s symptoms may be unique, and sometimes symptoms may not occur until months after birth. The most common symptom, however, is spastic diplegia, a medical term meaning tight, restricted muscles. Other symptoms may include:
- Loss of coordination
- Vision and hearing problems
- Cognitive impairment
- Impaired development
Spastic diplegia alone doesn’t always mean that babies have PVL. A full diagnosis must be done first to rule other medical conditions out. According to the Great Ormond Street Hospital for Children, cerebral palsy is the primary symptom of PVL. This is due to the high amount of children with PVL that develop the disorder.
Since PVL symptoms can mimic other disorders, physicians perform a tests to get an accurate diagnosis. The first test is generally a cranial ultrasound in which sound waves are used to view the infant’s brain. Another imaging test, the magnetic resonance imaging test (MRI), may be performed to provide a more in-depth, detailed view of the baby’s brain.
Treatment Options for PVL
There are no specific treatment options for PVL, but the child may go through a series of assessments in order to get a diagnosis on conditions that may develop due to PVL, such as cerebral palsy. Afterwards, depending on any other medical conditions, treatment may consist of physical, speech, and occupational therapy, medications, and assistive devices, if needed. Keep in mind that treatment for associated medical conditions are generally determined by:
- The infant’s age
- The severity of the medical condition
- How the infant handles (tolerates) certain medications and therapies
- You (the parents) opinion and decisions on treatment options
Some infants will PVL will have minor medical issues but otherwise remain healthy. On the other hand, babies with severe issues of PVL may have severe, long-term disabilities. Prognosis depends on what other medical conditions, if any, the baby develops as a result of PVL.
Is There Any Way to Prevent PVL?
Since PVL can be caused by unknown factors, prevention can be difficult. However, if an intrauterine infection is present, some doctors believe that in-depth tests during the 5th to 7th month of pregnancy can identify the infection and treat it, which may help to prevent PVL. Other doctors have stated that the testing is illogical since there’s no guarantee.
Regular medical checkups during pregnancy, while avoiding alcohol and drugs are the best ways to prevent PVL, although there is no guarantee, as sometimes PVL can still occur even with the best prenatal care.
In the meantime, researchers and scientists continue to research screening and testing to help better identify intrauterine infections. The National Institute of Neurological Disorder and Stroke (NIH) states that most of research being done regarding PVL is not only to prevent the condition, but also find better ways to treat infants diagnosed with PVL.
The good news, however, is that PVL is not a progressive disease, meaning it will not worsen over time. For instance, a baby with mild PVL will not grow to exhibit symptoms that an infant with severe PVL has.