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Spina Bifida PDF
Spina Bifida PDF
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cord or neural elements are exposed through
the opening in the spine, resulting in partial
or complete motor paralysis and sen sory
deficits within the parts of the body below
the spinal opening. The paralysis may be
so seve re that the affected individual is
unable to walk and may have urinary and
bowel dysfunction.
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Meningocele and myelomeningocele generally
involve a fluid-filled sac-visible on the back
protruding from the spinal canal In meningocele,
the sac may be covered by a thin layer of skin.
In most cases of myelomeningocele, there is
no layer of skin covering the sac and an area
of abnormally developed spinal cord tissue
usually is exposed.
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In addition to abnormal sen sation and
paralysis, another neurological complication
associated with spina bifida is Chiari II
malformation-a condition common in
children with myelomeningocele-in
which the brain stem and the cerebellum
(hindbrain) protrude downward into the
spinal canal or neck area. This condition
can lead to compression of the spinal
cord and cause a variety of symptoms,
including difficulties with feeding,
swallowing, breathing control,
choking, and changes in upper extremity
function (stiffness, swelling).
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How is it diagnosed?
n most cases, spina bifida is diagnosed
I prenatally, or before birth. However,
some mild cases may go unnoticed until
after birth (postnatal). Very mild forms
(such as spin a bifida occulta), in which
there may be no symptoms, may never
be detected.
Prenatal Diagnosis
The most common screening methods u sed
to look for spin a bifida during pregnancy
are second trimester (16th to 18th weeks of
gestation) maternal serum alpha fetoprotein
(MSAFP) screening and fetal ultrasoun d.
The MSAFP screen measures the level of a
protein called alpha-fetoprotein (AFP ), which
is made naturally by the fetus and placenta.
During pregn ancy, a small amount of AFP
normally crosses the placenta a nd enters
t he mother's bloodstream. Abnormally
high levels of th is protein in the moth er's
bloodstream may in dicate t hat the fetus
h as a n "open " (not skin-covered) neu ral
tube defect. The MSAFP test, however,
is not specific for spina bifida a nd requ ires
correct gestation al dates to be most accurate;
it cannot definitively deter mine that there is
a problem with the fetus.
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is a procedure in which th e doctor removes
ad examines samples of fluid from the
amniotic sac that surrounds the fetus.
Although amniocentesis cannot reveal
the seve rity of spina bifida, finding high
levels of AFP may indicate that the
disorder is present.
Postnatal Diagnosis
Mild cases of spina bifida (occulta; closed)
not diagnosed during prenatal testing may
be detected postnatally by X-ray during
a routine examination. Doctors may use
magnetic resonance imaging (MRI) or a
computed tomography (CT) scan to get a
clearer view of the spine and vertebrae.
Individuals with the more severe forms of
spina bifida often have muscle weakness in
their feet, hips, and legs. If hydrocephalus
is suspected, the doctor may request a CT
scan and/or X-ray of the skull to look for
extra cerebrospinal fluid inside the brain.
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How is spina bifida treated?
here is no cure for spina bifida. The nerve
T tissue that is damaged or lost cannot be
repaired or replaced, nor can function be
restored to the damaged nerves. Treatment
depends on the type and severity of the
disorder. Generally, children with the
mild form need no treatment, although
some may require surgery as they grow.
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Originally planned to enroll 200 expectant
mothers carrying a child with myelomeningocle,
the Management of Myelomeningocele
Study was stopped after the enrollment
of 183 women, because of the benefits
demonstrated in the children who underwent
prenatal surgery.
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becomes fastened to an immovable structure
(such as overlying membranes and vertebr ae).
This causes the spinal cord to b ecome
abnormally stretched and the vertebrae
elongated with growth and movement. This
condition can cause change in the muscle
function of the legs, as well as changes in
bowel and bladder function. Early surgery
on the spinal cord may allow the child to
regain a normal level of functioning a nd
prevent further neurological deterioration.
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Can the disorder be prevented?
olic acid, also called folate, is an
F important vitamin in the development
of a healthy fetus. Although taking this
vitamin cannot guarantee having a healthy
baby, it can help. Studies have shown that
by adding folic acid to their diets, women of
childbearing age significantly reduce their
risk of having a ch ild with a neural tube
defect such as spina bifida. Therefore, it is
recommended that all women of childbearing
age consume 400 micrograms of folic acid
daily. Foods high in folic acid include dark
green vegetables, egg yolks, and some fruits.
Many foods-such as some breakfast cereals,
enriched breads, flours, pastas, rice, and
other grain products- are now fortified
with folic acid. Most multivitamins contain
this recommended dosage of folic acid.
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personal and environmental factors. Many
children with the disorder h ave normal
intelligence and can walk, usually with
assistive devices. If learning problems develop,
early educational in tervention is helpful.
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tube closure, and to develop information t hat
will translate into improved clinical care,
treatment, and genetic counseling.
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Where can I get more information?
or more in formation on neurological
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disorders or research programs funded
by the National Institute of Neurological
Disorders an d Stroke, contact the Institu te's
Brain Resources and Information Network
(BR AIN) at:
BRAIN
P.O. Box 5801
Bethesda, MD 20824
800-352-9424
www.ninds.nih.gov
March of Dimes
1275 Mamaroneck Aven ue
White Plain s, NY 10605
914-997-4488
888-MODIMES (663-4637)
www.marchofdimes.com
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