Time for botox injections?

Now that Maria is at the ancient age of nearly 23 months, the doctors think it's time to start botox injections. More on that further down.

We just got back from the visit to the neurologist and neurosurgeon. They were absolutely ecstatic over her latest brain MRI. The thing about hydrocephalus is that an MRI shows that much of the brain is "missing" and replaced by fluid-filled ventricles. In some cases, the brain tissue is there, just squished into a smaller area by the fluid pressure. In other cases, the brain tissue is NOT there and that's part of the reason there is so much fluid (there is a lot of space to fill). With Maria, they were never sure which was the case.

This last MRI confirms that her brain looks normal and healthy, so the tissue was there it just needed to "fluff up" to fill the gaps. To my untrained eye, the MRI looked about the same as the one from a year ago, but they were much more excited over this one so there clearly has been some development since then.

She has normal reflexes and full range of motion in her limbs, though she was resistant to a lot of motions. However, resisitance is fine. With some neurological conditions, the limbs simply CAN'T move in certain directions even if forced. Although her limbs are stiff, they are able to move where they need to.

That is what leads to the botox. Although botox can be used to give self-indulgent celebrities that "made of wax" face that passes for youthful appearance in Hollywood, it also has actually useful applications. An injection of botox into her muscles could loosen them up for 3-6 months. It is a procedure used in kids with certain types of limb stiffness similar to Maria's. The neurosurgeon wasn't necessarily recommending it, but was saying we might ask the physical therapist what she thinks. I figure if she thought Maria needed it, she would have suggested it already. But I'm curious what her take on it will be.

Both neuros agreed that there is no need for ankle braces. Yes, her foot position is not great, but that's because she isn't walking (and because we don't put her in the stander as often as we should). Braces might still be in her future, but not now.

The lumbar MRI was also OK, so no spina bifida or cord tethering.

They think her developmental delays simply come from the fact that her brain couldn't develop while under pressure from the fluid, but my understanding is that the fluid pressure has been down for a long time. They were, of course, pessimistic about her future development (well, the neurologist was anyhow), but doctors often are and we'll just have to see if Maria once again proves them wrong.

The subtle pain response they think is just a sign of her cognitive delay. She feels pain, since she reacts to it, but she doesn't really understand pain so doesn't get as upset as a child with normal cognition might. They said the same thing about the no-crying thing. I can see that for the pain, but I still don't completely buy that for the crying. Newborn babies cry. They don't have to think about it or decide to do it. It's reflexive. The whole thing probably as important as I make it, but it just seems so odd.

Her weight is 25 lb, 8 oz which is less than it was a couple months ago, but just fine on the development charts (40th percentile). Her length is 31" (10th percentile) and her head circumference is 45 cm (5th percentile). So her physical development is fine.

Her shunt is also running fine.

All in all, some good and some bad. No real surprises, though. We won't see them again for another year.