Q: My 4.5 months old daughter is having brain injury in the parietal and occipital lobes of the brain since birth. She is having the problems of jerks and seizures. Previously she was not fixing her eyes. But now she has started to fix her eyes on the nearby objects. She smiles when we come close to her and also makes eye contact with us in the lying down position on the bed. But when we try to make her sit she doesn't look at us. She is not fixing her eyes in the sitting position and doesn't give any response too in this position. Why she is not fixing her eyes in the sitting position? Is there any chance of further improvement in her vision? Please advise.

A:In the newborn, the parieto-occipital areas of the brain suffer insults commonly due to hypoxiaischemia and hypoglycaemia. There are likely to be other nerve fibres and neurons in the brain that are affected which, the MRI may not pick up.

The various areas of the brain are intricately linked up and as such have multimodal functions. The occipital area primarily has a role in receiving, perceiving, analysing and interpreting images. The parietal area has intimate relations with the occipital lobe, and helps in scanning the world in front of us and the spatial relationships. Thus you can understand the problem your child is facing. This is called Cortical Visual Impairment. Over a period of months and a couple of years there will be an improvement in vision, but we can’t predict normalcy.

The second important issue is "jerks" - it is likely that the child may be evolving into Infantile Spasms. A good quality sleep EEG record will diagnose it. This epilepsy should be treated aggressively. A detail management protocol is not possible in this forum. I would suggest you meet your Neurologist.

Lastly, consult a developmental paediatrician and occupational therapist, so that exercises and intervention are started at the earliest.