Q: My 9 years old son has delayed milestones and 3 years after the birth we found that he has a speech disability too. After all the tests the doctor told us that he suffers from fronto-parietal pachygyria. Is there any treatment for this disorder? He is able to hear very nicely but cannot speak a word and he also has problems of fine motor movement. His IQ/SQ is 60 suggesting 40% disability. He goes to a special school. But now he is continuously drooling and is not gaining weight. He does not chew the food properly and his teeth are not in order. Can any medicine or treatment help him? Please advise.

A:In the developing brain, neurons must migrate from the areas where they are born to the areas where they will settle into their proper neural circuits. Neuronal migration, which occurs as early as the second month of gestation, is controlled by a complex assortment of chemical guides and signals. When these signals are absent or incorrect, neurons do not end up where they belong. This can result in structurally abnormal or missing areas of the brain in the cerebral hemispheres, cerebellum, brainstem, or hippocampus. Pachygyria is one of such disorders resulting in a thick and simplified cortex.

There is no treatment to re-alter the brain. Medications are used to treat the symptoms that arise from this disorder, like epilepsy, gait disorder, muscle weakness, etc.

There are children with pachygyria who remain very functional too. In your child’s case, I would recommend a good quality sleep EEG record, as a number of these children may have subtle fits, delayed language and the EEG may show epileptiform abnormalities. If this were so, then there may be an advantage in using medicines, and a possibility that language may improve.

In the meanwhile meet a Child Neurologist, and also start occupational therapy, speech therapy, and special education.