Polymicrogyria -Procedures, Side effects, Recovery time, Costs and alternatives

Polymicrogyria is a neurological condition in which an unusual development of the brain is observed while the baby is still in the womb. The neurons in the brain migrate to places where they are supposed to reach while the baby is in his/her mother’s womb. However, due to some unknown reasons the neurons become highly disorganized and reach places in the brain which is not correct for them.

A human brain is characterized by several folds commonly referred to as gyri. In the condition of polymicrogyria, the brain of the child develops way too many unusual small folds. This condition affects several aspects of the brain. The impairment of the brain due to polymicrogyria is based on which part of the brain gets affected. When only one side of the brain is affected then it is known as unilateral polymicrogyria. When both sides of the brain get severely affected it is referred to as bilateral polymicrogyria. The most common problems which may be experienced a patient includes severe epileptic seizures, difficulty in swallowing, difficulty in speech, and improper muscle movement. In the current scenario, the only way to diagnose a polymicrogyria disease is through MRI of the brain.

There is no treatment or cure available for patients who are suffering from the condition of polymicrogyria. The treatment that is given to these patients is usually based on the diseases caused by polymicrogyria. For the patients experiencing seizures due to polymicrogyria anti- epileptic medications are prescribed as the first line of treatment. However, it has been observed that the medicines for seizures sometimes is not adequate enough for managing the intensity and frequency of the seizures thus a doctor may prescribe a surgical procedure by the name of hemispherectomy. This surgical procedure has proven to be very successful in reducing the frequency of seizures in the patient suffering from polymicrogyria. For the patients suffering from other conditions such as difficulty in speech and swallowing a doctor may prescribe speech therapy for the patient.

Polymicrogyria may cause different problems for different patients who are suffering from this condition. The most common problem experienced is that of seizures. For the treatment of seizures, a doctor may prescribe medications which help in the control and management of the seizures. There is a wide range of anti-epileptic drugs available at the disposal of the doctor which he/she may prescribe to be given to the patient. Based on the type of seizure a doctor may prescribe drugs like carbamazepine, valproic acid, ethosuximide, and phenytoin. These medications have been approved by the FDA to be used in children suffering from seizures.

If the intensity and the frequency of seizures are very high then a doctor prescribes hemispherectomy be performed. This surgical procedure works best in children suffering from severe seizure problem due to polymicrogyria. Hemispherectomy can also be used for treating a lack of muscle coordination in patients with polymicrogyria. In this surgical procedure, the side of the brain which is affected by polymicrogyria is disconnected from the side which is not affected by polymicrogyria. This surgery is particularly successful in children because after the surgery the neurons from the unaffected part of the brain can pick up the functions of the affected part of the brain after the disconnection of both the parts.

In patients suffering from the problem of speech inability and swallowing difficulty, the doctors prescribe speech therapy as a treatment. A speech therapist may make use of the following techniques based on the need of an individual patient

• Language therapy
• Improvement in stuttering
• Improvement of voice
• Improvement in articulation
• Training for memory and attention
• Swallowing therapy

The speech and swallowing rehabilitation therapy lasts for an average session of 40 to 60 minutes and is done one a one-on-one type.

A patient who has been diagnosed with seizure due to polymicrogyria is eligible for treatment with the medicines. For the speech and swallowing therapy the patients who are having the problem in their speech are eligible. Patients who are suffering from the problem of articulation are eligible for this treatment. Patients suffering from the problem of swallowing are eligible for the treatment. The eligibility of a patient for hemispherectomy is based on the following conditions

• When a patient is suffering from severe epileptic seizures.
• A patient having an abnormality on side of the brain.
• Lack of coordination in the muscle movement of the patient
• When a condition of restricted maturation is occurring due abnormality of the brain.

Whether a patient is eligible or not for any treatment is decided by the doctor based on the medical history of the patient. Patients who are suffering from the problem of polymicrogyria are bound to exhibit disorders associated with the disease. The most common problems experienced are that of seizure, speech and swallowing problems. There is rarely a patient who does not experience any problem after being diagnosed with polymicrogyria. Thus, there may be no patient who is not eligible for treatment.

Every treatment that requires either surgery or medication has some major or minor side effects associated with it. Generally, it has been observed that minor side effects do not last long and disappear soon. However, in case of a serious side effect, a doctor must be informed immediately. The side effects of anti-epileptic medications, when given to patients suffering from polymicrogyria, are

• rashes on the skin
• drowsiness
• blurred vision
• abdominal pain
• vomiting
• nausea

The patients who are undergoing treatment through speech therapy do not exhibit any side effect. However, if the speech and swallowing therapy is not yielding the desired result it may have an effect on the mental health of the patient.

A patient who has undergone hemispherectomy for the treatment of polymicrogyria may exhibit the following side effects :

• A patient may have surgical site infection
• A patient might bleed into an empty space
• A patient may go to a coma for some weeks
• Hydrocephalus. In case any of these side effects persists or there any other health issues arising during or after treatment, it is advised to kindly consult the health specialist immediately.

The post-treatment guidelines for patients undergoing treatment with anti-epileptic medications include taking medicine at the prescribed time. The dose of medicine should not be missed. If any dose it missed then a double dose of the medicine should not be taken for compensating the missed dose as it can further complicate the condition of the patient. For patients undergoing treatment with speech therapy, the only post-treatment guideline is to continue the therapy for some time and then it must be reduced slowly. The therapy should not be discontinued abruptly. However, it is recommended therapy must be continued in some form at the home of the patient. The patients who are undergoing treatment with hemispherectomy the post-treatment guidelines are as follows :

• the complete course of antibiotic must be done
• the pain medications must be taken as advised by the doctor
• a patient must undergo speech therapy if required
• the patient must be properly monitored.
• Regular physiotherapy is required for the patient.

Usually, the recovery of patients suffering from polymicrogyria is very slow. For diseases caused by polymicrogyria the prognosis may be varied. A patient may be required to take the anti- epileptic medication for the rest of their lives in some cases. The recovery of patients undergoing treatment with speech therapy may range from 3 months to several years based on the complexity of the condition. Majority of the patients undergoing hemispherectomy recover within 6 to 8 weeks but they may further be required to go for speech therapy.

The price of anti-epileptic medicine in India ranges from 100 rupees to 500 rupees per strip based on the power of the medicine. In small Indian cities, a speech therapist costs 200 to 300 rupees per consultation. In metro cities, the cost of consultation ranges from 500 to 700 rupees per consultation.

Some world-renowned speech therapist may charge nearly 2000 to 2500 rupees per consultation. The cost of hemispherectomy in India is way cheaper in comparison to the United States and the United Kingdom. The average cost of hemispherectomy in India ranges from 1,50,000 to 3,00,000 lakh rupees based on the type of surgery and location.

The result of the disease based treatment in polymicrogyria may be considered permanent in some ways. When a patient is prescribed anti-epileptic medication it helps in managing the seizures but there is a strong possibility it may reoccur sometime in the near future. Similar is the scenario for speech therapy as the results might appear to be permanent but they return after some time. Only 60 percent of the patients who undergo hemispherectomy report permanent treatment while in others they still have to consult the doctor again for the treatment of seizures.

Polymicrogyria does not have any cure available. The treatments that are available are for the problems which arise due to polymicrogyria. For patients who are suffering from a seizure can use some natural herbs for relief in their condition like mistletoe, and groundsel. There some natural remedies for speech problems as well for instance making use of India Gooseberry, and applying lukewarm Brahmi oil on the head.