Understanding Periventricular Leukomalacia

Let’s unravel the mystery of brain injury

Life’s tender beginnings are meant to be beautiful and precious. However, in very rare cases, little babies, especially premature infants, may develop a neurological condition known as Periventricular Leukomalacia that impair motor control and cognitive function.

In this blog, we’ll help you understand the intricacies of Periventricular Leukomalacia and its impact on the developing brain.

What is Periventricular Leukomalacia?

Periventricular Leukomalacia (PVL) is a neurological condition that affects premature infants. It is characterized by damage to the white matter that surrounds the cerebral ventricles, the regions in the brain that are critical for cognitive function and motor control. PVL is primarily caused by complications during premature birth. Typically, due to insufficient oxygen or limited blood flow to delicate brain regions, the damage can be extensive.

Although PVL is lifelong, it can be managed with early intervention, supportive care, as well as therapeutic approaches that focus on minimizing the brain injury’s impact on the child’s development.

Causes of Periventricular Leukomalacia

The exact cause of PVL is difficult to ascertain. However, research suggests that the condition is caused by lack of oxygen and blood flow to the brain. As mentioned above, this is a risk that is heightened during a premature birth, because the brains of premature babies are extremely fragile and prone to injury. Other factors that can be attributed to PVL include:

Intraventricular hemorrhage (bleeding in the brain)
Rupture of membranes (in the amniotic sac) during premature birth
Uterine infections

Symptoms of Periventricular Leukomalacia

The most common symptoms of PVL include:

Vision trouble
Difficulty in eye movements
Trouble with gross and fine motor movements
Tight muscles
Developmental delays (these become more apparent as the milestone windows are surpassed)

Note: Infants and children with PVL can exhibit all or some of the above mentioned symptoms. Early detection is critical for early intervention and supportive treatments.

Although PVL primarily affects premature infants, there have been instances of the impact of PVL extending well into adulthood, resulting in late-onset or persistent symptoms. Periventricular Leukomalacia symptoms in adults can be:

Motor impairments
- Abnormal gait
- Balance and coordination difficulty
- Muscle weakness and/or stiffness

Cognitive impairment
- Attention and concentration troubles
- Executive function deficits
- Memory problems

Speech and communication difficulties
- Trouble with articulation
- Trouble with expressive language (verbal, non-verbal, written)
- Persistent language challenges

Vision disturbances, particularly depth perception or visual-motor integration
Fatigue
Difficulty in performing everyday tasks
Difficulty in adapting to educational or work environments
Increased predisposition to secondary conditions, such as joint issues or contractures because of restricted mobility

Therapeutic Approaches to PVL at Plexus

The most widely prescribed and recommended treatments for PVL include physiotherapy, speech therapy, occupational therapy, and vision therapy.

At Plexus, we pride ourselves on being India’s most advanced centre for the above mentioned therapies. What’s more, we also offer PVL rehabilitation packages that are tailored to suit your precious little one’s needs.

Stem Cell Therapy for Periventricular Leukomalacia

Known for their anti-inflammatory and immunomodulatory properties, mesenchymal stem cells (MSCs) have shown incredible promise in managing PVL. By differentiating into new nerve cells, MSCs have been known to promote neurogenesis, reduce inflammation, and provide trophic support to tissue damaged by the condition. At Plexus, we use MSCs sourced from the patient (adipose tissue, bone marrow, etc.) or from umbilical cord tissue.

Physiotherapy for Periventricular Leukomalacia

The primary focus areas of physiotherapy for PVL are enhancing strength, mobility and coordination, as well as addressing any other unique challenges faced by the child. After a tailored assessment, our highly trained physiotherapists will provide a personalized program that may consist of a combination of the following targeted interventions:

Muscle tone management
Gait training
Balance and coordination enhancement
Achievement of developmental milestones
Assisted devices

Occupational Therapy for Periventricular Leukomalacia

Occupational therapy at Plexus enhances the child’s functional abilities that are impeded by PVL. Our programs are designed to foster independence and encourage meaningful participation in daily life. To this end, we offer the following:

Fine motor skill development
Activities of daily living (ADL) training
Sensory integration
Cognitive skills enhancement
Adaptive equipment
Emotional support and counseling
School readiness

Speech Therapy for Periventricular Leukomalacia

Following an early communication assessment, our highly skilled speech and language therapists will offer targeted interventions that address communication and language challenges, as well as encourage effective expression. We help your child to:

Hold conversations with others
Speak clearly and intelligibly
Develop higher self-esteem
Confidently participate in school and social settings

Vision Therapy for Periventricular Leukomalacia

While motor and cognitive impairment are most commonly associated with PVL, there are rare instances of the child’s vision and eye health being severely impacted too. For these cases, vision therapy is recommended to promote optimal visual skills, as well as improving overall functionality.

Following a visual assessment, a visual therapist will create a therapeutic program that comprises the following:

Eye teaming and tracking exercises
Binocular vision training
Visual motor integration activities
Sensory integration
Visual field expansion
Colour and contrast sensitivity training
Assistive devices

Along with therapeutic rehabilitation, medical interventions and support from family and caregivers can greatly enhance the quality of life of these little lives affected by PVL.

FAQs

Can a baby with PVL live a normal life?

Early therapeutic interventions like physical therapy, occupational therapy, speech therapy, and supportive care can empower many children with PVL to lead fulfilling lives.

Can PVL be cured?

The treatment for PVL focuses on managing symptoms and improving functionality. Early intervention and therapies have been known to greatly enhance a child’s quality of life.

What is the best treatment for PVL?

Presently, the treatment for PVL follows a multifaceted therapeutic approach involving physical, occupational, and speech therapies. In order to address specific symptoms your child’s doctor may prescribe certain medications too. Surgery is considered only in severe cases. Your child’s doctor will be able to provide you with a personalized approach based on your little one’s unique needs.

How serious is PVL?

PVL is a serious condition, primarily affecting premature infants. There have been very severe cases of PVL that have resulted in cerebral palsy, or other serious mental and physical delays.

What causes PVL in babies?

Premature birth leading to oxygen deprivation or blood flow issues during the perinatal period contribute to white matter damage around the cerebral ventricles, leading to PVL in babies.