Case Report: Long-Term Survival in a Child with Alobar Holoprosencephaly—Developmental Improvement with Supportive Pharmacotherapy

Holoprosencephaly (HPE) is a severe congenital brain malformation characterized by incomplete division of the prosencephalon, with the alobar form being the most severe and usually incompatible with long-term survival. Most affected infants die in utero or in the early neonatal period, and those who survive typically show profound neurodevelopmental impairment with minimal progress. Here, we report the case of a male child with MRI-confirmed alobar HPE who presented with seizures, gastroesophageal reflux, and severe developmental delay in early infancy but subsequently achieved partial developmental gains and longterm survival beyond three years. The child was managed with a combination of antiepileptic medications, supportive pharmacological interventions, neuroenhancers, and structured physiotherapy, leading to sustained seizure control, improvement in feeding, reduction of spasticity, and attainment of motor and social milestones including head control, prone-to-supine turning, abdominal crawling, babbling, and social interaction. This report highlights the potential for individualized multimodal management to improve quality of life and extend survival even in severe malformations like alobar HPE, and it underscores the importance of reporting rare cases that challenge existing prognostic expectations.