27 July, 2017
Periventricular White Matter Disease is not actually a disease. This misnomer comes from health practitioners referring to it as such, but periventricular white matter is commonly occurring on the brain, and changes in this matter are common as people age. Lesions, which are identified through imaging, may lead to a "disconnect" between certain regions of the brain, thereby creating confusion, poor balance or dementia.
Periventricular White Matter (PWM) has several causes, including aging, mini strokes or conditions related to multiple sclerosis. Studies have shown that more than a third of MRIs done on people over age 65 show some PWM. The condition has also been linked to a vitamin B6 deficiency. PWM might be caused by small strokes or migraines. Researchers believe that small bleeds in the brain are sometimes the cause of the lesions.
Among the symptoms of PWM is reduced walking speed and difficulty with balance. And while walking more slowly is a symptom, it is not necessarily indicative of a lesion as people tend to walk more slowly and carefully as they age. Another symptom may be confusion or reduced mental ability. Depending on the location of lesion, the capability to think clearly or perform a certain task may be impaired.
Taking small doses of B6 supplements and reducing stress are recommended. Reducing hypertension and quitting smoking are also key preventative measures. In addition, 20 percent of those suffering from migraines have a 20 percent chance of developing lesions (compared to 1.4 percent of the general population). Managing migraines using beta blockers in combination with other migraine medication is key to lowering the risk of developing lesions.
Once lesions have appeared, the effects are permanent. Treatment may help to adapt to new issues (i.e. unsteadiness) or slow the process, but as yet it cannot be reversed. Physical therapy is a key component of managing PWM. There is little evidence to show that a drug regimen will help to diminish the effects of PWM. However, research suggests that antidepressants and antiparkinsonian medications may be helpful in some cases. In addition, if a patient is already taking medication that impacts the brain or ability to think, tweaking the dosage or switching to a similar medication may help alleviate the symptoms.
PWM may be preventable, but should you develop it, the key to living with it is finding a way to manage it. While there is no indication that if one lesion appears, others will follow, individual lesions may get larger over time, causing additional impairment. Location of a lesion is also important with regards to what motor skills are affected. Physical therapy will help to manage the affected skills.