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SPINA BIFIDA National Institute of Neurol. Disorders and Stroke - NIH

SPINA BIFIDA National Institute of Neurol. Disorders and Stroke - NIHSam Lazuardi

SPINA BIFIDA SB - 1Is a type of neural tube defect, which is a problem with the spinal cord or its coveringsIt happens it the fetal spinal cord doesnt close completely during the 1st mo of pregnancyUsually there is nerve damage that causes some paralysis of the legs need assisted devices (braces, crutches or wheelchairs), have learning difficulties, urinary & bowel problems or hydrocephalus

SPINA BIFIDA SB - 2There is no cureTreatment focus on the complications & include surgery, medicine and physiotherapyTaking folic acid can reduce the risk of having a baby with Spina BifidaSB occurs in various forms, each varying in severity

SPINAD BIFIDA OCCULTA - SBOMildest form results in a small gap in one or more of the vertebrae of the spineSpinal nerves arent involved -> no signs or symptoms & no neurol problemsVisible indications of SBO can be seen on the skin above the spinal defect : abn tuft of hair, a collection of fat, a small dimple of birthmark, skin discolorationD/ X- ray

OTHER FORMS OF SBMeningocele : the meninges around the spinal cord push out through the opening in the ver-tebrae, because the spinal cord develops nor-mally, the membranes can be removed by surgery with little or no damage to the nerves.Myelomeningocele : open SB, is the most severe form : the spinal canal remains open along several vertebrae, both the membrane & spinal cord protrude forming a sac on the back, tissues & nerves are exposed & prone to life-threatening infections

MYELOMENINGOCELENeurological impairment is common, incl :Muscles weakness, sometimes paralysisBowel & bladder problemsSeizures, especially if the child requires a shuntOrthopedic problems (deformed feet, uneven hips and scoliosis)

RISK FACTORSRace (more common among whites, hispanics)Family history of neural tube defectsFolate deficiencySome medications : anti-seizure medication (valproate)Diabetes, who dont control the blood sugar ObesityIncreased body temp (fever, sauna, hot tubs)

COMPLICATIONSPhysical & neurological problems : lack of normal bowel-bladder control & partial or complete paralysis of the legsHydrocephalusMeningitisOther complications : learning disabilities, latex allergies, skin problems UTI, gastrointes-tinal disorders & depression

TESTS AND DIAGNOSISMaternal serum alpha-fetoprotein (MSAFP) test -> test for alpha- fetoproteinUSG if blood test indicates high AFP levelsAmniocentesis when USG is N, but high AFP -> look for AFP level in amnion fluid

TREATMENTS AND DRUGSMeningocele -> surgery to put meninges back Myelomeningocele -> surgery within 24 48 hrs after birth to minimize risk of infectionHydrocephalus -> shuntPrenatal surgery, before th 26th week of preg-nancy - nerve function worsen rapidly after birthCesarean birth (myelomeningocele with breech position)

PREVENTIONAll women of childbearing age to take 400 mcg folic acid daily, folic acid help also to reduce other birth defects incl. cleft lip, cleft palate and some congenital heart defectsFoods rich in folate : beans, citrus fruits, egg yolks, dark green veggies (spinach, broccoli)Higher dose 4000 mcg 4 mg, 1 mo before conception 1st few mo of pregnancy if you take anti-seizure medications, diabetes or given birth to a child with SB