developmental delays--metopic

[jennahlynne]

Hi there, my son carter has gross motor and speach delays he is reciveing therapy for both...Is this realted to mild metopic with trigon?

[paynesmom]

There does seem to be at least a slightly higher incidence of delays with metopics. But they just don't know if the severity (of the trigon) coorelates. It doesn't seem to in the study below. (Which is surprising...you would think that the more severe would cause more delays but it doesn't work that way.)
http://journals.lww.com/jcraniofacia...ity_of.23.aspx

It is just one more mystery of the Metopic Cranio condition.


Edit: (This study actually only speaks for one of the problems you asked about. I apologize. I don't know as much about the gross motor delays.)

[Mindy]

Here is the issue with the studies. They can't prove a cause and effect relationship meaning the premature closure causes the delays. All they know is that the correlation exists. In some cases, it may be syndromatic where you see a whole host of characteristics with metopic cranio being one of those characteristics associated with a specific syndrome. But, in the other non-syndromatic cases of cranio, the correlation has been reported in literature. Sometimes I wonder if the frontal part of the brain, which controls language development and other cogntive functions, could be, in some children, growing at a slower rate than the rest of the brain causing the metopic suture to fuse earlier (result in trigon.) since the skull expands by brain growth. Its like which came first, the chicken or the egg. In any case, the delays are treated with early intervention.

As for your question, I have seen cases of speech delay and less gross motor delay with metopic on here, but then there are children who are fine despite pretty significant trigon. so, who knows??

[paynesmom]

Mindy, you mention some of the same things I wonder about all the time. I really really wish there were more studies done on this. It seems like there could be. I know there are things in the medical field that are just never going to be known, especially with the brain, but I feel like they could figure some of this out.

[Mindy]

I know what you mean Amanda. The thing is that in order to study this, they would need to actually look at the brains of very young children (infants) and look at their development as well to see if things are on track and then monitor for closure of the suture. It would be very difficult with too many variables to account for. Dr. Staffenberg has once mentioned to me that some surgeons wonder if it is possible to actually have a localized increase in pressure just in the frontal part of the brain as a result of premature closure which could account for some of the delays, but no such study has yet to analyze that since it would be difficult to get a parent of a non-cranio kid and cranio kid to agree to have a probe inserted into their child's head to get normative and non-normative values. Some of those studies that show increased pressure on mild metopics (those awful japanese studies) actually measure the pressure while in the OR and according to Dr. Fearon, pressure is elevated from anesthesia so those results aren't valid. So, its so hard to draw conclusions from this type of research. All we can do is trust our own instincts when our mommy gut tells us something isn't right. But, I often do think about the chicken and egg theory b/c it does make sense.

[Shar]

It would make sense in our case since H has no delays. It's pretty likely that her early fusion is due to her being breech. So for her and some kids it's in utero positional and with that maybe they have no delays. I mean REALLY ! Big speculation I'm making, but it sure would be nice to have some solid answers!

[Lauren]

As language is a constantly developing skill, the parts of the brain that control it can also vary by a few centimeters. That sounds like a small amount, but really its huge. There are studies that show that if there is an insult of any kind (tumor, injury, lack of oxygen, etc), the language centers migrate to compensate for the damaged tisse.

Mindy is right. There is no way to know for sure but given the plasticity of the brain it is unlikely that the suture synostosis is the sole "cause" of any delay.

[Shar]

Wow! That is really cool, Lauren! I love the thought of the brain doing that! Amazing!

[Lauren]

It happens all the time. People have strokes or brain injury and relearn the skills because the brain is wired to do whatever it can to work right. Even severe epileptics who have had the corpus collosum (the bridge between the right and left hemispheres) cut to stop seizures have been able to "reassign" different parts of the brain to do taks that used to be controlled by the other side.

We probably only understand about 10% of what the brain is capable of. Actually, when I was in grad school it was 10%, I'll guess we understand 20-25% now. Humbling isn't it?

[kking]

I know Austin's case is more "severe" - but at 12 mos. his speech nearly stopped except for babbling which became less and less. By surgery at 22 mos, he was hardly making much noise. Our neurosurgeon at Johns Hopkins told us that he sees many metopic cranio cases with speech issues. And for Austin, his case was so severe, he didn't know if he'd ever talk again due to the amount of pressure that impacted the frontal lobes. Thankfully, Austin is talking and some days won't shut up. LOL We saw slow improvement after surgery with speech therapy, but it did come back .... with a vengance. :) (he had surgery at 22 mos and again at 3).