Achondroplasia Health Article

Treatment and management

There is no cure for achondroplasia. The recommendations for the medical management of individuals with achondroplasia have been outlined by the American Academy of Pediatrics' Committee on Genetics. The potential medical complications of achondroplasia range from mild (ear infections) to severe (spinal cord compression). By being aware of the potential medical complications and catching problems early, it may be possible to avert some of the long-term consequences of these complications. An individual with achondroplasia may have some, all, or none of these complications.

All children with achondroplasia should have their height, weight, and head circumference measured and plotted on growth curves specifically developed for children with achondroplasia. Measurements of head circumference are important to monitor for the development of hydrocephalus—a known but rare (<5%)

complication of achondroplasia. Hydrocephalus (or water on the brain) is caused by an enlargement of the fluid-filled cavities of the brain (ventricles) due to a blockage that impedes the movement of the cerebrospinal fluid. Suspected hydrocephalus can be confirmed using imaging techniques such as a CT or MRI scan and can be treated with neurosurgery or shunting (draining) if it causes severe symptoms. Any child displaying neurologic problems such as lethargy, abnormal reflexes, or loss of muscle control should be seen by a neurologist to make sure they are not experiencing compression of their spinal cord. Compression of the spinal cord is common in individuals with achondroplasia because of the abnormal shape and small size of their foramen magnum (opening at the top of the spinal cord).

All children with achondroplasia should be monitored for sleep apnea, which occurs when an individual stops breathing during sleep. This can occur for several

reasons, including obstruction of the throat by the tonsils and adenoids, spinal cord compression and obesity. Individuals with achondroplasia are more prone to sleep apnea due to the changes in their spinal canal, foramen magnum, and because of their short necks. Treatment for sleep apnea depends on its cause. Obstructive sleep apnea is treated by surgically removing the tonsils and adenoids. Neurosurgery may be required to treat sleep apnea due to spinal cord compression. Weight management may also play a role in the treatment of sleep apnea.

Other potential problems in children with achondroplasia include overcrowding of the teeth (dental malocclusion), speech problems (articulation), and frequent ear infections (otitis media). Dental malocclusion (overcrowding of teeth) is treated with orthodontics. All children with achondroplasia should be evaluated by a speech therapist by two years of age because of possible problems with the development of clear speech (articulation). Articulation problems may be caused by orthodontic problems. Due to the abnormal shape of the eustachian tube in an individual with achondroplasia, they are very prone to ear infections (otitis media). Approximately 80% of infants with achondroplasia have an ear infection in the first year of life. About 78% of these infants require ventilation tubes to decrease the frequency of ear infections.

Weight management is extremely important for an individual with achondroplasia. Excess weight can exacerbate many of the potential orthopedic problems in an individual with achondroplasia such as bowed legs, curvature of the spine, and joint and lower back pain. Excess weight can also contribute to sleep apnea. Development of good eating habits and appropriate exercise programs should be encouraged in individuals with achondroplasia. These individuals should discuss their exercise programs with their health care provider. Because of the potential for spinal cord compression, care should be used in choosing appropriate forms of exercise.

The social adaptation of children with achondroplasia and their families should be closely monitored. Children with visible physical differences can have difficulties in school and socially. Support groups such as Little People of America can be a source of guidance on how to deal with these issues. It is important that children with achondroplasia not be limited in activities that pose no danger. In addition to monitoring their social adaptation, every effort should be made to physically adapt their surroundings for convenience and to improve independence. Physical adaptations can include stools to increase accessibility and lowering of switches and counters.

Two treatments have been used to try to increase the final adult height of individuals with achondroplasia–limb-lengthening and growth hormone therapy. There are risks and benefits to both treatments and they are still considered experimental.

Limb-lengthening involves surgically attaching external rods to the long bones in the arms and legs. These rods run parallel to the bone on the outside of the body. Over a period of 18-24 months the tension on these rods is increased, which results in the lengthening of the underlying bone. This procedure is long, costly, and has potential complications such as pain, infections, and nerve problems. Limb-lengthening can increase overall height by 12-14 in (30.5-35.6 cm). It does not change the other physical manifestations of achondroplasia such as the appearance of the hands and face. This is an elective surgery and individuals must decide for themselves if it would be of benefit to them. The optimal age to perform this surgery is not known.

Growth hormone therapy has been used to treat some children with achondroplasia. Originally there was doubt about the effectiveness of this treatment because children with achondroplasia are not growth hormone deficient. However, studies have shown that rate of growth in children with achondroplasia treated with growth hormone does increase during the first two years of treatment. It is too early to say how effective this treatment is because the children involved in this study are still growing and have not reached their final adult height.