Bilateral Frontal Polymicrogyria (BFPMG)

Bilateral frontal polymicrogyria is a rare brain malformation that forms before birth. “Polymicrogyria” means “too many small folds” on the brain surface. In this condition, the problem affects both frontal lobes (right and left) in a fairly symmetric way. Under the MRI, doctors see a thick-looking cortex made of many tiny ridges, with an irregular gray–white boundary because the normal brain layers did not form in the usual way. Children commonly have developmental delay, problems with speech and movement, and sometimes seizures. This pattern was first described as a distinct syndrome in a 13-patient series and is now recognized as one of the localized bilateral PMG patterns. PMC+3PubMed+3Genetic Rare Diseases Center+3

Bilateral frontal polymicrogyria means both frontal lobes of the brain formed with “too many small folds” before birth. These extra tiny folds make the brain surface bumpy and the layers inside are not arranged in the usual way. Because the frontal lobes help with movement, speech planning, learning, attention, and behavior, children and adults with BFPMG may have motor delay, stiff or tight muscles (spasticity), speech and language problems, learning differences, seizures, and challenges with attention or behavior. There is no cure that “rebuilds” the cortex; treatment focuses on seizures, movement, feeding, communication, and supports for learning and independence across the lifespan. MedlinePlus+1

BFPMG can happen for several reasons that all affect how the brain forms during pregnancy. Causes include gene changes (variants) in pathways that guide brain growth and cell movement, reduced blood flow to parts of the fetal brain, and some infections during pregnancy such as cytomegalovirus (CMV) or Zika. Many families never learn a single cause; modern genetic testing (exome or large gene panels) finds an explanation in roughly a third of cases in recent studies. Preventing certain infections and getting prenatal care lowers—but never eliminates—the risk. Nature+2JAMA Network+2

Not the same as “bilateral frontoparietal polymicrogyria (BFPP).” BFPP extends into the parietal lobes and is usually caused by variants in GPR56/ADGRG1; BFPMG is limited to the frontal lobes and is often sporadic or genetically heterogeneous. Keeping these names separate avoids confusion. ScienceDirect+2Wiley Online Library+2

---

Other names

You may see these phrases used in clinics or articles. All point to the same frontal-only, both-sides pattern.

• Bilateral frontal polymicrogyria (BFPMG / BFP)

• Symmetric frontal polymicrogyria

• Bilateral frontal PMG
  These labels reflect the same core idea: PMG confined to both frontal lobes. Experts@Minnesota+2Genetic Rare Diseases Center+2

---

Types

There is no single official subtype list for BFPMG, but clinicians often describe it in these useful ways:

1. Isolated BFPMG – only the frontal PMG is present, with otherwise typical brain structure. Children usually show motor and speech delay and may or may not have seizures. PubMed

2. BFPMG with additional malformations – BFPMG plus other findings (e.g., under-connected white matter tracts, thin corpus callosum). The overall picture can be more complex. SpringerLink

3. BFPMG suspected to be genetic – family history, consanguinity, or variants found on exome/genome sequencing (for PMG in general, many genes are known). OUP Academic+1

4. BFPMG suspected to be acquired (non-genetic) – prenatal injury or infection patterns on imaging or lab tests (e.g., congenital CMV) suggesting a non-genetic cause. American Journal of Neuroradiology+1

---

Causes

Polymicrogyria has many causes. For BFPMG, causes fall into two broad buckets—genetic and prenatal environmental/injury. Below are 20 well-supported causes or cause-patterns; your child may have one, several, or none identified even after testing.

1. Sporadic (unknown) cause – Many BFPMG cases are isolated with no clear trigger found even after testing. The original case series noted the pattern was often sporadic. PubMed

2. Single-gene variants (PMG in general) – PMG can result from variants in multiple genes that control neuronal migration and cortical patterning (e.g., TUBB2B/tubulinopathies, WDR62, EMX2, RELN, DCX). The exact gene often guides prognosis and counseling. SpringerLink+2MedlinePlus+2

3. Tubulinopathy (e.g., TUBB2B) – Tubulin genes help neurons move to the right place; variants can cause frontal-predominant PMG. MalaCards

4. Centrosome and spindle genes (e.g., WDR62) – Disrupted cell division/migration leads to malformed cortex, sometimes with frontal emphasis. SpringerLink

5. Transcription factors (e.g., EMX2) – Early brain patterning genes; changes may yield regional PMG. MalaCards

6. Reelin pathway (RELN) – Guides neurons into proper layers; dysfunction can produce multi-regional PMG. MalaCards

7. Doublecortin (DCX) – Classically linked to lissencephaly/double cortex, but PMG patterns are described in the spectrum. MalaCards

8. Copy-number changes (chromosomal) – PMG reported with microdeletions like 1p36 or 22q11.2; these are detected by chromosomal microarray. Wiley Online Library

9. mTOR/PI3K pathway variants – Broader MCD group evidence shows PI3K–AKT–mTOR genes can cause cortical malformations, sometimes including PMG. JAMA Network

10. Congenital cytomegalovirus (CMV) – A well-known prenatal infection cause of PMG; MRI patterns plus early PCR testing support diagnosis. American Journal of Neuroradiology+1

11. Congenital Zika virus – Zika exposure in pregnancy has been associated with PMG among other brain injuries, sometimes with frontal involvement. CDC+1

12. Prenatal ischemia/hypoxia – Poor blood flow to the developing frontal cortex can disrupt cortical layering and folding. SpringerLink

13. Twin pregnancy complications – Vascular events in monochorionic twins can injure cortex and contribute to PMG patterns. SpringerLink

14. Peroxisomal disorders – Inborn errors of metabolism occasionally show PMG within a broader neuroimaging picture. ScienceDirect

15. Syndromic associations (PMG in a syndrome) – PMG may appear alongside recognized syndromes; identifying the syndrome can direct care. SpringerLink

16. Environmental teratogens (probable/possible) – Certain toxic exposures in early gestation can disrupt cortical development, though individual proof is often difficult. SpringerLink

17. Maternal systemic disease – Severe, uncontrolled maternal illness (e.g., prolonged hypoxia) can contribute to fetal brain injury and malformation. SpringerLink

18. Autozygosity/consanguinity as a risk marker – Some families in the first BFPMG report had consanguineous parents, supporting an autosomal-recessive mechanism in a minority. PubMed

19. Post-zygotic (mosaic) variants – Some PMG arises from variants present in a subset of fetal cells; blood testing may miss them, making diagnosis harder. OUP Academic

20. Still “cryptogenic” after testing – Even with modern exome/genome sequencing and microarray, some children have no cause found; repeated re-analysis can help. OUP Academic

---

Symptoms and everyday signs

Symptoms vary with extent and with other brain findings. These are common in BFPMG and other bilateral PMG patterns:

1. Global developmental delay – Sitting, walking, talking, and learning arrive later than for most children. Early therapy helps. OUP Academic

2. Speech and language delay – Words come late. Sentences are short. Some children need alternative communication support. Genetic Rare Diseases Center

3. Fine-motor delay – Hand skills like grasping small objects or using a pencil are hard. OUP Academic

4. Gross-motor delay – Rolling, crawling, standing, and walking take extra time and support. OUP Academic

5. Spasticity (stiff muscles) – Increased tone, especially in the legs and sometimes all four limbs (spastic diplegia/tetraparesis). Genetic Rare Diseases Center

6. Weakness – Hemiparesis (one side) or quadriparesis (all four limbs) can be present and affect daily activities. Genetic Rare Diseases Center

7. Abnormal reflexes – Tendon reflexes become brisk or spread more than usual; toe may go up (Babinski sign). Genetic Rare Diseases Center

8. Seizures – May be focal or generalized; some children have atypical absences, tonic/atonic “drop attacks,” or mixed seizure types. Epilepsy Foundation

9. EEG abnormalities – Brain-wave tests often show focal or multifocal spikes that match the malformation. PMC

10. Learning difficulties or intellectual disability – Ranges from mild to moderate in many reports. Genetic Rare Diseases Center

11. Feeding/swallow issues or drooling – Due to oromotor dysfunction and pseudobulbar signs in some children. epilepsydiagnosis.org

12. Behavior/attention problems – Executive skills come from frontal lobes; attention and planning can be affected. SpringerLink

13. Speech praxis/oral motor planning problems – Trouble coordinating mouth movements for speech. epilepsydiagnosis.org

14. Microcephaly (in some) – Head size may be small; not universal. OUP Academic

15. Normal strength or near-normal function (in mild cases) – Some children with limited BFPMG can have milder problems than expected. The spectrum is wide. OUP Academic

---

Diagnostic tests

A) Physical examination

1. General pediatric and neurological exam – Checks tone, strength, reflexes, coordination, gait, and cranial nerves. It gives the first map of what functions need support. NCBI

2. Developmental surveillance during well-child visits – The American Academy of Pediatrics (AAP) recommends ongoing milestone checks at every visit. AAP

3. Standardized developmental screening at set ages – AAP recommends formal screening (e.g., at 9, 18, and 30 months) and autism screening at 18 and 24 months. This finds delays early so services can start. AAP Publications+1

4. Infant/child neurologic exam techniques – Age-adapted approaches (e.g., primitive reflexes in infants; observation-based coordination checks in toddlers). Stanford Medicine+1

5. Tone assessment in spasticity – Clinicians often use the Modified Ashworth Scale (MAS) to grade muscle tone so therapy goals can be tracked over time. NCBI

B) “Manual” bedside functional tests

6. Gross Motor Function Classification (GMFCS) level – Describes how a child moves (sits, stands, walks) to guide equipment and therapy planning. PMC

7. Gait observation and balance tasks – Watching walking pattern, sitting balance, and transfers shows how tone and weakness affect daily life. PMC

8. Upper-limb function checks – Reach, grasp, release, bimanual tasks, and hand preference help tailor OT programs. PMC

9. Speech/oral-motor examination – Looks at lip, tongue, palate movement, and swallowing safety when pseudobulbar signs are suspected. epilepsydiagnosis.org

10. Cognitive/behavioral assessment appropriate to age – Simple play-based or school-based measures to plan supports and IEPs. PMC

C) Laboratory & pathological tests

11. Chromosomal microarray (CMA) – Screens for small missing/extra DNA pieces (copy-number variants) linked to PMG (e.g., 1p36, 22q11.2). First-line when a syndromic cause is suspected. Wiley Online Library

12. Clinical exome sequencing (± genome) – Finds single-gene causes across the many PMG-associated genes; periodic re-analysis can raise the diagnostic yield. OUP Academic

13. Targeted gene panels – When the MRI pattern or family history points to a gene subset (e.g., tubulin genes), panels can be used. ScienceDirect

14. Testing for congenital CMV (if suspected) – Saliva and/or urine PCR within the first 21 days of life confirms congenital infection; saliva positives should be confirmed with urine. East of England+2MN Dept. of Health+2

15. Infection work-up in pregnancy/infancy as indicated – When history suggests prenatal infection (e.g., Zika exposure), clinicians follow public-health testing guidance. CDC

D) Electrodiagnostic tests

16. Electroencephalography (EEG) – Detects seizure patterns and localizes epileptiform discharges that often match the malformed cortex. Important for choosing anti-seizure therapy. PMC

17. Long-term/video EEG monitoring – Used when spells are unclear or surgery is discussed; ties clinical events to EEG changes. Epilepsy Foundation

18. Auditory brainstem response (ABR) when CMV suspected – Screens objective hearing since CMV can damage the inner ear. CDC

E) Imaging tests

19. Postnatal brain MRI (gold standard for PMG) – T1/T2/FLAIR sequences show excessive tiny gyri, a thickened cortex, and a “festooned” or bumpy gray–white junction in the bilateral frontal lobes up to the precentral gyrus and frontal operculum—exactly the BFPMG map. Radiopaedia+1

20. Prenatal imaging when suspected – Fetal MRI (plus ultrasound) can detect malformations of cortical development in late second/third trimester; findings guide counseling and planning. Wiley Online Library

Non-pharmacological treatments (therapies & other supports)

1) Physical therapy (PT)
Purpose: Improve strength, balance, coordination, and safe movement in daily life.
How it works: Guided exercises and play-based tasks help the nervous system “practice” better movement patterns and keep joints flexible, which counters spasticity and prevents contractures. PT also teaches caregivers safe handling and positioning to reduce pain and falls. Child Neurology Foundation

2) Occupational therapy (OT)
Purpose: Build independence in feeding, dressing, writing, using switches, and self-care.
How it works: OT breaks skills into small steps, uses adaptive tools (grips, splints, seating), and repetitive practice to strengthen brain-body connections for real-world tasks. Child Neurology Foundation

3) Speech-language therapy (SLT)
Purpose: Support speech, language, and safe swallowing.
How it works: Therapists train muscle coordination for sounds, teach language through play/storytelling, and run swallow therapy with texture changes and posture strategies to reduce choking and aspiration. AACD Medicine

4) Augmentative & alternative communication (AAC)
Purpose: Give a reliable voice when speech is hard.
How it works: From picture boards to eye-gaze tablets, AAC offloads the motor plan for speech so the person can express needs, feelings, and learning—boosting participation and behavior. ASHA

5) Ketogenic or other medical diets (for hard-to-control seizures)
Purpose: Reduce seizures when multiple anti-seizure medicines have failed.
How it works: High-fat, very low-carb diets create ketosis; ketone bodies change brain energy use and reduce excitability. Must be prescribed and monitored by an experienced team. Alternatives include modified Atkins and low glycemic index therapy. PMC+1

6) Orthoses & seating (AFOs, custom wheelchairs)
Purpose: Prevent contractures, improve standing and walking efficiency, protect joints, and increase comfort.
How it works: Braces and custom seating optimize body alignment, reduce energy cost of movement, and distribute pressure to avoid pain and skin breakdown. espghan.org

7) Constraint-induced movement & task-specific training
Purpose: Improve use of a weaker side.
How it works: Temporarily “constraining” the stronger limb plus intense, goal-focused practice drives neuroplasticity—helping the brain re-map pathways for the weaker side. Child Neurology Foundation

8) Behavioral therapy & caregiver training
Purpose: Support attention, behavior, and routines.
How it works: Structured schedules, positive reinforcement, and visual supports reduce frustration, improve sleep routines, and make daily care safer and calmer. Epilepsy Foundation

9) Educational supports & individualized education plans (IEPs)
Purpose: Match teaching to a student’s learning profile.
How it works: Special education, assistive tech, extra time, and therapy minutes build skills, while accommodations reduce barriers to demonstrating knowledge. Epilepsy Foundation

10) Feeding therapy & nutrition support
Purpose: Improve growth, hydration, and safe swallowing.
How it works: Texture changes, pacing, positioning, and caregiver training lower aspiration risk. A dietitian ensures enough calories, protein, fiber, and micronutrients for growth and bone health. AACD Medicine

11) Sleep hygiene
Purpose: Better sleep to reduce daytime seizures, irritability, and fatigue.
How it works: Fixed bed/wake times, dim lights/screens, and a calming routine strengthen the body clock; melatonin may be considered with a clinician if behavioral steps aren’t enough. HealthyChildren.org

12) Seizure action plan & rescue training
Purpose: Fast, consistent response to seizures at home or school.
How it works: Written steps, trigger management, rescue-med instructions, and staff training reduce injuries and delays in care. Epilepsy Foundation

13) Hydrotherapy, hippotherapy, and adaptive sports
Purpose: Build strength, balance, and confidence with less joint stress.
How it works: Water buoyancy and rhythmic horse movement provide graded challenges that encourage posture control and coordination in fun settings. Child Neurology Foundation

14) Vision & hearing services
Purpose: Optimize sensory input that supports learning and mobility.
How it works: Glasses, low-vision strategies, and hearing aids/cochlear support are matched to testing to improve communication and safety. Wiley Online Library

15) Social work & care coordination
Purpose: Reduce caregiver stress and connect to services and equipment.
How it works: Navigation help for therapy schedules, funding, transportation, respite, and community programs keeps care sustainable. Epilepsy Foundation

16) Respiratory & airway management
Purpose: Lower risk from poor tone, drooling, or aspiration.
How it works: Positioning, oral-motor programs, suction planning, and reflux control reduce chest infections and hospitalizations. AACD Medicine

17) Orthopedic monitoring
Purpose: Catch hip displacement, scoliosis, or foot deformities early.
How it works: Regular exams and x-rays guide bracing, Botox, or surgery planning before pain and stiffness limit function. espghan.org

18) Cognitive & neuropsychological rehabilitation
Purpose: Support attention, memory, and executive skills.
How it works: Targeted tasks, checklists, and environmental supports help plan, persist, and finish tasks at home and school. Child Neurology Foundation

19) Community safety & first-aid training
Purpose: Prevent injuries and prepare for emergencies.
How it works: Seizure first aid, water safety, helmet use, and travel planning reduce risk and increase participation. Epilepsy Foundation

20) Family peer support & mental health care
Purpose: Reduce isolation and burnout; build coping skills.
How it works: Support groups and counseling help families manage uncertainty and long care journeys. Epilepsy Foundation

---

Drug treatments

1) Levetiracetam (Keppra/Generics)
Purpose: Broad-spectrum anti-seizure medicine.
Class/Mechanism: Binds SV2A; modulates neurotransmitter release to calm over-excitable networks.
Dosing/Time: Oral or IV, typically twice daily; pediatric dosing is weight-based per label.
Side effects: Irritability, fatigue, dizziness; rare mood changes. FDA Access Data

2) Lamotrigine (Lamictal)
Purpose: Focal and generalized seizures; also Lennox-Gastaut.
Class/Mechanism: Voltage-gated sodium channel blocker; stabilizes neuronal membranes.
Dosing/Time: Slow titration (once/twice daily) to reduce serious rash risk; follows exact label schedules especially with valproate or enzyme inducers.
Side effects: Rash (rarely SJS), dizziness, headache. FDA Access Data

3) Valproate (Valproic acid/Valproate sodium; Depakene/Depacon)
Purpose: Broad-spectrum seizures including generalized types.
Class/Mechanism: Increases GABA and modulates sodium/calcium channels.
Dosing/Time: Weight-based; multiple daily dosing or ER once daily; lab monitoring.
Side effects: Weight gain, tremor, liver and pancreas toxicity; teratogenic—specialist counseling required. FDA Access Data

4) Topiramate (Topamax)
Purpose: Focal and primary generalized tonic-clonic seizures; LGS adjunct.
Class/Mechanism: Multiple—sodium channels, GABA, AMPA/kainate antagonism, carbonic anhydrase inhibition.
Dosing/Time: Usually twice daily with gradual titration.
Side effects: Cognitive slowing, weight loss, kidney stones, paresthesias. FDA Access Data

5) Oxcarbazepine (Trileptal)
Purpose: Focal seizures (common in PMG).
Class/Mechanism: Sodium channel blocker.
Dosing/Time: Twice daily; pediatric weight-based.
Side effects: Low sodium (hyponatremia), dizziness, rash. FDA Access Data

6) Lacosamide (Vimpat)
Purpose: Focal seizures (≥4 years, per label updates).
Class/Mechanism: Enhances slow inactivation of sodium channels.
Dosing/Time: Oral/IV; usually twice daily; weight-based in children.
Side effects: Dizziness, PR-interval prolongation—ECG caution. FDA Access Data

7) Clobazam (Onfi)
Purpose: Adjunct for Lennox-Gastaut and other difficult epilepsies.
Class/Mechanism: Benzodiazepine; enhances GABA-A.
Dosing/Time: Once/twice daily; titrate to effect.
Side effects: Sedation, drooling, constipation; tolerance possible. FDA Access Data

8) Rufinamide (Banzel)
Purpose: Lennox-Gastaut adjunct; may help drop attacks.
Class/Mechanism: Modulates sodium channel inactivation.
Dosing/Time: Weight-based, divided doses with food.
Side effects: Dizziness, vomiting; QT-shortening cautions. FDA Access Data

9) Perampanel (Fycompa)
Purpose: Focal seizures (± GTCS) adjunct.
Class/Mechanism: Noncompetitive AMPA receptor antagonist.
Dosing/Time: Once nightly; start low and go slow.
Side effects: Dizziness, behavioral changes; falls risk. FDA Access Data

10) Cannabidiol (Epidiolex)
Purpose: LGS, Dravet, TSC seizures; sometimes used off-label in other refractory epilepsies under specialist care.
Class/Mechanism: Plant-derived cannabidiol; multiple CNS targets.
Dosing/Time: Oral solution; mg/kg/day divided twice daily; watch liver tests, interactions (esp. valproate/clobazam).
Side effects: Sleepiness, diarrhea, elevated LFTs. FDA Access Data

11) Vigabatrin (Sabril)
Purpose: Infantile spasms; refractory focal seizures adjunct.
Class/Mechanism: Irreversible GABA-transaminase inhibitor ↑GABA.
Dosing/Time: Weight-based; regular vision checks due to risk of peripheral vision loss.
Side effects: Visual field loss (boxed warning), sedation, weight gain. FDA Access Data

12) Felbamate (Felbatol)
Purpose: Severe refractory epilepsy (e.g., LGS) when benefits outweigh risks.
Class/Mechanism: NMDA antagonist; GABA effects.
Dosing/Time: Divided daily doses; careful lab monitoring.
Side effects: Aplastic anemia, liver failure (boxed warnings). FDA Access Data

13) Zonisamide (Zonegran)
Purpose: Adjunct for focal seizures.
Class/Mechanism: Sodium and T-type calcium channel effects; carbonic anhydrase inhibition.
Dosing/Time: Once/twice daily.
Side effects: Kidney stones, decreased sweating, appetite loss. FDA Access Data

14) Brivaracetam (Briviact)
Purpose: Adjunct or mono-therapy for focal seizures.
Class/Mechanism: SV2A ligand (high affinity).
Dosing/Time: Twice daily; fewer interactions than some ASMs.
Side effects: Drowsiness, dizziness, mood symptoms. FDA Access Data

15) Stiripentol (Diacomit)
Purpose: Dravet syndrome adjunct (with clobazam/valproate).
Class/Mechanism: GABAergic modulation; CYP inhibitor.
Dosing/Time: Divided doses with food; monitor interactions.
Side effects: Appetite loss, sleepiness, neutropenia (monitor). FDA Access Data

16) Carbamazepine (Tegretol)
Purpose: Focal seizures; avoid in generalized myoclonic/absence.
Class/Mechanism: Sodium channel blocker.
Dosing/Time: Twice/three times daily; monitor sodium, blood counts; HLA testing in some ancestries.
Side effects: Hyponatremia, rash, dizziness. FDA Access Data

17) Phenobarbital
Purpose: Long-used ASM, especially in infants where indicated.
Class/Mechanism: GABA-A positive modulation.
Dosing/Time: Once daily at bedtime typical; serum levels sometimes checked.
Side effects: Sedation, cognitive effects; bone health monitoring. FDA Access Data

18) Diazepam rectal gel (Diastat) – rescue
Purpose: Stop clusters or prolonged seizures per action plan.
Class/Mechanism: Benzodiazepine (GABA-A); rapid abortive therapy.
Dosing/Time: Single weight-based dose per label; may repeat as directed.
Side effects: Sleepiness, breathing suppression—use exactly as prescribed. FDA Access Data

19) Midazolam nasal spray (Nayzilam) – rescue
Purpose: Rapid treatment of clusters in appropriate ages.
Class/Mechanism: Benzodiazepine; intranasal for speed and ease.
Dosing/Time: Age/weight-based; one spray, second if needed per label.
Side effects: Sedation, respiratory depression; caregiver training needed. FDA Access Data

20) Diazepam nasal spray (Valtoco) – rescue
Purpose: Alternative intranasal rescue for clusters.
Class/Mechanism: Benzodiazepine; quick absorption through nasal mucosa.
Dosing/Time: Age/weight-based; follow action plan.
Side effects: Sleepiness, nasal discomfort; watch breathing. FDA Access Data

Important: Medication choices depend on seizure type, age, comorbidities, and interactions. Always follow your neurologist’s plan and the exact product label.

---

Dietary molecular supplements

1) Omega-3 fatty acids (EPA/DHA from fish oil)
Help overall brain and heart health and may modestly affect seizure thresholds in some people. Typical supplemental amounts range widely; clinicians often individualize dosing. Always consider interactions and quality. Office of Dietary Supplements

2) Vitamin D
Supports bones and muscles; many children on long-term ASMs need monitoring and supplementation to maintain normal blood levels. Dosing is individualized based on serum 25-OH-D. digitalmedia.hhs.gov

3) Magnesium
An essential mineral for nerve and muscle function; replace if deficient. High doses can cause diarrhea or interact with meds—dose only per clinician advice. digitalmedia.hhs.gov

4) Vitamin B6 (pyridoxine)
Key cofactor in neurotransmitter pathways; targeted use in specific epilepsies or deficiency states, with careful dosing to avoid neuropathy from excess. digitalmedia.hhs.gov

5) L-carnitine
Sometimes used with valproate exposure to support mitochondrial fat handling and help prevent or treat valproate-related liver or ammonia problems, under specialist guidance. PMC+1

6) Melatonin
A hormone that can help sleep initiation when behavioral steps aren’t enough; start low and only under pediatric guidance. Quality and dosing matter. HealthyChildren.org

7) Probiotics
May support bowel regularity in children with limited mobility or ketogenic diets; strains and benefits vary, so use clinician guidance. Epilepsy Foundation

8) Fiber (soluble/insoluble)
Dietary or supplemental fiber helps constipation common with low mobility or certain diets/meds; increase gradually with fluids. Epilepsy Foundation

9) Multivitamin/mineral (KDT users)
Ketogenic and modified diets often need targeted vitamin/mineral supplementation planned by the dietitian. PubMed

10) MCT oil (when part of KDT plan)
Provides fat that makes ketones efficiently; only within a medically supervised dietary therapy. Epilepsy Foundation

Immunity booster / regenerative / stem-cell” drugs

There are no FDA-approved regenerative or stem-cell drugs that repair polymicrogyria. Families should avoid unproven stem-cell clinics. Immune “boosters” are not treatments for BFPMG. Instead, evidence-based prevention focuses on vaccines and RSV monoclonal antibodies when indicated. ASHA

1) Routine childhood vaccines (per CDC schedule)
Purpose: protect against infections that could worsen illness or cause hospital stays.
Mechanism/dose: follow age-based CDC schedule and special notes; clinicians use shared decision-making for newer items. CDC+1

2) Seasonal influenza vaccine
Purpose: prevent flu complications that can destabilize seizures.
Mechanism/dose: annual vaccination per age and risk. CDC

3) Pneumococcal conjugate vaccine (PCV)
Purpose: reduce pneumonia, ear, and invasive disease risk—important for children with aspiration or medical complexity.
Mechanism/dose: follow CDC age/risk schedule. CDC

4) COVID-19 vaccination (shared decision-making in 2025)
Purpose: lower risk of severe COVID and hospitalization.
Mechanism/dose: current CDC guidance uses shared decision-making for healthy children; discuss with your clinician. The Washington Post

5) Palivizumab (Synagis) – monthly RSV prophylaxis in select high-risk infants
Purpose: reduce severe RSV disease.
Mechanism/dose: monoclonal antibody; 15 mg/kg IM monthly during RSV season in eligible infants per label. FDA Access Data

6) Nirsevimab (Beyfortus) – long-acting RSV prophylaxis
Purpose: season-long protection for infants entering their first RSV season, with defined catch-up groups.
Mechanism/dose: single IM dose (50 mg or 100 mg based on weight) per label. FDA Access Data

---

Surgeries / procedures

1) Vagus nerve stimulation (VNS)
Why: For drug-resistant epilepsy when resection isn’t an option (common with bilateral malformations).
How: A pacemaker-like device sends timed pulses to the vagus nerve to lower seizure burden over months. Evidence supports use in children and LGS; infection and hoarseness are notable risks. PubMed

2) Corpus callosotomy
Why: For dangerous “drop attacks” when medications fail.
How: Disconnecting the main bridge between hemispheres reduces seizure spread and injuries; cognition is usually preserved, but risks and candidacy are individualized. American Academy of Neurology

3) Intrathecal baclofen (ITB) pump
Why: Treat severe spasticity interfering with comfort, care, or mobility.
How: A pump delivers baclofen to spinal fluid, relaxing muscles with lower systemic side effects than oral dosing. Requires refills and device care. dhcs.ca.gov

4) Selective dorsal rhizotomy (SDR)
Why: Reduce disabling lower-limb spasticity in carefully selected children.
How: Cutting selected sensory nerve rootlets lowers reflex-driven tone; best with intensive rehab and strict criteria from a spasticity team. ilae.org

5) Gastrostomy tube (G-tube)
Why: For unsafe swallowing, poor growth, or need for reliable medication/fluid delivery.
How: A feeding tube placed through the abdomen supports nutrition and reduces aspiration risk, improving energy and participation. AACD Medicine

---

Preventions

1. Prenatal care with folic acid, chronic-condition control, and infection screening. While folate prevents neural tube defects (not PMG), good prenatal care lowers overall risk. FDA Access Data

2. CMV hygiene in pregnancy: avoid saliva sharing, wash hands after diapering/daycare exposures. FDA Access Data

3. Zika precautions: follow travel and mosquito-avoidance guidance if pregnant or planning pregnancy. ilae.org

4. Vaccinations for household and the child per CDC schedules to prevent serious infections. CDC

5. Avoid alcohol, tobacco, and illicit drugs in pregnancy. FDA Access Data

6. Manage maternal illnesses (e.g., diabetes, hypertension, fever) with obstetric guidance. FDA Access Data

7. Safe delivery and newborn care to reduce hypoxia and infection risks. Wiley Online Library

8. Genetic counseling for families with known variants or recurrent history. JAMA Network

9. Environmental toxin awareness (e.g., lead avoidance). FDA Access Data

10. Early developmental surveillance to start therapies promptly. Child Neurology Foundation

---

When to see doctors (red flags)

Seek urgent care for a first seizure, a seizure lasting >5 minutes without rescue medicine effect, repeated clusters, breathing problems, blue color, injury, or if the seizure pattern suddenly changes. Call your team sooner for feeding trouble, poor weight gain, frequent choking, new weakness, increased stiffness or pain, regression of skills, or daytime sleepiness from medicines. Have a written seizure action plan and rescue meds if prescribed. Epilepsy Foundation

---

What to eat and what to avoid

1. Eat: balanced meals with fruits, vegetables, proteins, whole grains, and healthy fats to support energy and bone health. Avoid: nutrient-poor ultra-processed foods as the main diet. Epilepsy Foundation

2. Eat: calcium- and vitamin-D-rich foods (or supplements if advised). Avoid: long periods with low calcium/vitamin D while on long-term ASMs. digitalmedia.hhs.gov

3. Eat: enough fiber and fluids for bowel regularity. Avoid: sudden large fiber increases without fluids. Epilepsy Foundation

4. Eat (if on KDT/MAD): only the plan your dietitian prescribes. Avoid: do-it-yourself “keto” without medical supervision. PubMed

5. Eat: safe textures if dysphagia is present. Avoid: choking-risk foods unless approved after swallow therapy. AACD Medicine

6. Hydrate well. Avoid: dehydration, which can worsen constipation and overall wellness. Epilepsy Foundation

7. Limit caffeine if it worsens sleep or anxiety. Avoid: energy drinks in teens. Epilepsy Foundation

8. Consider omega-3s from fish or clinician-approved supplements. Avoid: high-dose supplements without guidance. Office of Dietary Supplements

9. Maintain regular mealtimes to stabilize energy. Avoid: long fasting unless part of a supervised diet therapy. Epilepsy Foundation

10. If rescue meds are used with food needs (e.g., KDT), follow your team’s exact instructions for timing. Avoid: changing carb/fat ratios on your own. PMC

---

FAQs

1) Is BFPMG lifelong?
Yes. It reflects how the brain formed before birth; care focuses on function and safety through therapies, seizure control, and supports. Epilepsy Foundation

2) Will everyone have seizures?
No. Seizure risk is increased but varies by pattern and extent; if present, many need more than one treatment approach. PMC

3) What test confirms it?
MRI with experienced interpretation; EEG and genetic tests add important information for care planning. Epilepsy Diagnosis+1

4) Can a special diet help?
For drug-resistant epilepsy, ketogenic or related diets can reduce seizures under a trained team. PubMed

5) Are there medicines proven by the FDA for seizures?
Yes—many anti-seizure medicines have FDA labels; the best choice depends on seizure type and the person’s profile. FDA Access Data+1

6) Are stem-cell therapies approved for BFPMG?
No approved regenerative/stem-cell therapies exist for PMG; avoid unproven clinics. ASHA

7) Can surgery cure seizures in BFPMG?
Because both frontal lobes are affected, resective surgery is often not feasible; VNS or callosotomy may reduce seizures and injuries. PubMed

8) Why are speech and behavior affected?
Frontal lobes plan speech and behavior; when their wiring is different, planning and control can be harder—AAC and therapies help. MedlinePlus

9) How often should we see therapists?
Frequency depends on goals and progress; teams adjust PT/OT/SLT blocks during growth or skill changes. Child Neurology Foundation

10) Do vaccines worsen seizures?
Vaccines prevent serious infections; clinicians follow CDC schedules and individualize advice. CDC

11) Is melatonin safe for sleep?
Use under pediatric guidance; start low and pair with sleep hygiene. Evidence suggests benefit but quality varies. HealthyChildren.org

12) What if swallowing is unsafe?
Work with SLT and dietetics; if needed, a G-tube can safely support growth and meds. AACD Medicine

13) Which rescue medicine is easier at school?
Intranasal midazolam or diazepam are often practical; follow the written seizure action plan. FDA Access Data+1

14) Can genetics change our care?
Sometimes yes—results can guide surveillance, therapies, counseling, and family planning. JAMA Network

15) What is the outlook?
Outcomes vary widely. Early, team-based care improves comfort, safety, communication, and independence. Child Neurology Foundation

Disclaimer: Each person’s journey is unique, treatment plan, life style, food habit, hormonal condition, immune system, chronic disease condition, geological location, weather and previous medical  history is also unique. So always seek the best advice from a qualified medical professional or health care provider before trying any treatments to ensure to find out the best plan for you. This guide is for general information and educational purposes only. Regular check-ups and awareness can help to manage and prevent complications associated with these diseases conditions. If you or someone are suffering from this disease condition bookmark this website or share with someone who might find it useful! Boost your knowledge and stay ahead in your health journey. We always try to ensure that the content is regularly updated to reflect the latest medical research and treatment options. Thank you for giving your valuable time to read the article.

The article is written by Team RxHarun and reviewed by the Rx Editorial Board Members

Last Updated: October 24, 2025.