Wednesday, January 18, 2017

What Exactly is Rhombencephalosynapsis?

Over the past few years this blog has taken on many different roles. Sometimes it is informational, and other times funny. We have shed a tear or two here and have hopefully provided some good information for new Rhombencephalosynapsis families. I am going to head back to the informational side for a few posts and try to break down the diagnosis in laymens terms, but without cutting the important medical information. When Abby was first diagnosed I was so completely overwhelmed by all of the medical jargon but little did I know that it was critical that I get familiar with this information. Over the past two years I have served as the expert in the room on RS even when five doctors are present.

What is Rhombencephalosynapsis?

Rhombencephalosynapsis is a brain malformation where the cerebellum is fused at the midline, rather  than being a separated structure. The severity of the diagnosis is like that of a curve. There are people living with Rhombencephalosynapsis who have almost no symptoms of the diagnosis. There are others who suffer from very severe cases of RS, often paired with other genetic and medical anomalies. These families may live with wheelchairs, feeding tubes and resporators as a part of their day-to-day routine.

In the most recently published study on Rhombencephalosynapsis, Dr. Doherty and his staff at the University of Washington noted that individuals outcome can be correlated with the degree of malformation in the brain. Meaning children that have a fused cerebellum but have a vermis will have better outcomes than children who have no vermis, other structural abnormalities and additional genetic issues. This being said Abby was born with RS, hydrocephalus, enlarged 3rd and 4th ventricles, a chiari malformation and partial agenesis of the corpus callosum. When they told us she would never walk or talk that seemed a very real possibility. However, kids with RS are also born with an amazing ability to overcome.  

How is Rhombencephalosynapsis Diagnosed?

An increasing number of children are receiving their diagnosis in utero. In some cases when the standard anatomy ultrasound is conducted, the malformation can be detected. In many cases (like ours) the medical professionals picked up on a non-specific issue with midline areas of the brain, but no specific diagnosis. In cases such as these, an MRI will detect the malformation. Abby underwent a CT scan and 1.5 tesla MRI before doctors at CHOP moved on to a higher resolution 3 tesla MRI, which finally uncovered her specific diagnosis. There are people in the RS community who were diagnosed much later in life. 

What are the major implications of Rhombencephalosynapsis?

Delayed Milestones:

Most children with Rhombencephalosynapsis miss milestones from the very beginning of life. They are slow to hold up their head, roll over, sit up, crawl and walk. It is not unusual for RS kids to be delayed in walking for up to 2-3 years. Abby had a particularly hard time learning to roll over. She passed other developmental milestones before she could roll over. Most kids will eventually meet their milestones. 

Impaired Fine Motor Skills:

One of the most globally experienced symptoms of Rhombencephalosynapsis is weak fine motor skills. Things like using zippers, typing shoes, holding a pencil, writing and other hand-based skills are well behind similarly age peers. It is very helpful for a family to seek the services of an occupational therapist early to help mediate these issues. 

Impaired Gross Motor Skills:

Like fine motor delays, kids with Rhombencephalosynapsis tend to also experience delays and difficulty in their gross motor skills. These would be things as basic as walking, balancing, running, standing on one foot and playing sports. In this area, a physical therapist can help strengthen muscles, develop tone and improve balance. 

Impaired Balance:

Often leading to falls and bumps is impaired balance. Kids with Rhombencephalosynapsis will often topple over, fall, trip or lose their balance. As a parent watching your child fall more than the average toddler can be painful. Many Rhombencephalosynapsis families choose to use walkers, helmets and other devices to help keep kids safe. We installed "Care Rails" on our steps to make sure maneuvering stairs was a safe activity for Abby. Along with impaired balance, many kids with Rhombencephalosynapsis lack what is known as protective reflexes. This would be something like raising your hands to break a fall instinctively. 

Low Muscle Tone:

A lack of good muscle tone is also very common in cases of Rhombencephalosynapsis. Working with a physical therapist can help improve muscle mass, which will help mitigate the symptoms of low muscle tone. 


A great number of children with Rhombencephalosynapsis experience the symptoms of strabismus, which is crossing of the eyes. This diagnosis is generally made by an ophthalmologist. The most common treatments include patching, glasses and surgery. We chose to have Abby eyes surgically repaired and her results were very good. 

Sensory System Issues:

Many parents of kids with Rhombencephalosynapsis report that they experience a range of sensory system disruption. Abby was diagnosed with Sensory Processing Disorder very early in life. She then worked with an occupational therapist to develop what is referred to as a "sensory diet." What this means is that when a child has sensory information enter their system (what they see, smell, hear, feel and taste) they have a difficult time organizing this information and making good use of it. 

Social and Behavioral Issues:

Kids with Rhombencephalosynapsis commonly struggle with some form of social or behavioral difficulty. Some kids experience severe issues, while others are very minimal. In Abby's case she often lacks the filter to know not to say things. She can be insensitive, lack empathy and come across as difficult. She struggles in school to follow the rules on some occasions. As she is maturing, we are seeing this less and less. The height of her behavioral troubles was between 3 and 4 years of age.

Additional Signs and Symptoms:

Alopecia, My goal is to write a series of articles that covers each of these topics in greater detail. While I can only write from our experiences and perspective I welcome fellow RS families to give input through comments and I will happily add that information.

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