Periventricular Leukomalacia (PVL)

How Is PVL Diagnosed?

Since PVL symptoms may appear similarly to other disorders, a complete diagnosis must be made to rule out other conditions. The most common ways to diagnose PVL include: 

• Neurological and developmental exams: Pediatric neurologists and developmental specialists will start by evaluating a child's muscle tone, reflexes, posture, coordination, and early milestones. Follow-ups tracking progress can detect emerging issues like cerebral palsy or vision problems as the child grows and make sure treatment is started early to prevent long-term complications. 
• Cranial ultrasound: This test uses sound waves to view and detect white matter injury and PVL around the ventricles in the brain. It's often the first test performed at the bedside in the NICU because it's safe, fast, and noninvasive. 
• Magnetic resonance imaging (MRI): MRI uses strong magnets, radio waves, and a computer to show more detailed information about subtle white matter and brain tissue damage that ultrasound can miss. It is usually done in early childhood to better clarify prognosis. 

How Is Periventricular Leukomalacia Treated?

There is no cure that can reverse the brain tissue damage caused by PVL. Treatment will focus on managing secondary symptoms from complications such as cerebral palsy or other developmental delays. Always consult your child's doctor or pediatric neurologist before starting any treatment.

As a child grows, some treatments may include:

• Physical therapy: Helps to improve muscle strength, balance, and coordination. Therapists can help with exercises that involve stretching tight muscles, practicing motor skills, and preventing contractures. 
• Occupational therapy: Makes daily tasks and self-care like feeding and dressing easier. OT also helps children adapt to school environments and participate in play.
• Speech therapy: If a child has challenges speaking, exercises to help with communication, speech clarity, and sometimes feeding/swallowing difficulties can make a big difference. 
• Assistive devices and/or mobility aids: Braces (orthotics), walkers, wheelchairs, adaptive seating, or communication devices may be recommended depending on the child's needs. 
• Medications or surgery: In some cases, medication or surgery may be needed (ongoing or temporary) to help with spasticity, seizures, and other conditions. 

Note: Not every child with PVL will develop the same symptoms and require all or any of the treatments above. The type of treatment that may be recommended depends on the child's age, severity of the condition, response to medications, and whether parents feel it is right for their child. 

What Is the Long-Term Outlook for PVL?

The prognosis for PVL depends on how widespread and severe the white matter damage is, the child's overall health, and how soon early treatment and care begins. 

Mild PVL: Children may have minor coordination or learning difficulties but overall live very independent lives.

Moderate PVL: They may have a higher risk of motor delays, cerebral palsy (often spastic diplegia), and learning differences. Some may require physical therapy or other treatments to help manage symptoms.

Severe PVL: More likely to experience significant motor disabilities, cognitive dysfunction, epilepsy, or vision problems. Those with severe PVL may have long-term care needs depending on which areas of function are affected and the type of complications that are co-occurring.

It's important to remember that no two children are exactly alike. Many families say that their child surprises them — sometimes doing much more than early scans suggested, especially when therapy and support are started early, giving hope for parents and children about their future outlook.