Spina Bifida as a Neurological Condition

Spina Bifida as a Neurological Condition

Myelodysplasia commonly referred to as Spina bifida, is a neurological condition in which normal development and function of the vertebrae and nerves around the spinal cord are impaired. It is defined as a developmental defect due to a failure of fusion of the neural tube around the 28th day of gestation (Zipitis and Paschalides 2003). The condition causes some parts of the spinal cord and adjacent body parts to protrude from the rest of the body. The problem can occur at any segment along the spine. The condition changes the physical appearance of the skin surrounding the spinal cord, making it blister-like while a significantly advanced case may also affect walking and other activities. This paper analyzes Spina bifida as a neurological condition with regard to causes, symptoms, diagnosis, treatment, and its prevention and management initiatives.

Background Information

Spina bifida is more common in Hispanics than any other race. It is significantly less common in Caucasians and Blacks. Also, Spina Bifida is more prevalent in Europe and the Americas compared to Asia and Africa. It mainly affects females and is recurrent among infants. There have been significantly more cases in the 1960s than there are today. The percentage reduction in cases of Spina bifida has moved from a massive 80% for every 1000 individuals in the 1960s to the current 0.62% for every 1000 individuals (Zipitis and Paschalides 2003). On the other hand, 1 out of every 2000 children in the world have Spina bifida. (Meuli et al. 1995). The reduction of more than 20% of the cases today has been largely due to the aggressive prenatal termination of pregnancies. In recent times, a number of researches have been dedicated to the effectiveness of folic acid in the management of Neural Tube Defects, (NTDs). Despite the low number of cases of Spina bifida, there is still cause to address this problem affecting children because it severely damages the children's lives and futures. As such, the affected group and their care givers should be made to understand the problem more comprehensively. Hence, the acceptance of the condition for care givers is important to catering to a patient with Spina bifida. Accepting the patient's conition and dedicating time and effort to caring for them is associated with the increased psychological morbidity for those who offer care. (Zipitis and Paschalides 2003)

Consequently, across the globe, 400,000 fetuses are in one way or another affected by various types of NTDs. Spina bifida being the second most common form of NTD therefore affects a very significant number of fetuses (Wingate et al. 2004). Spina bifida shuts off the spinal cord from its link to the brain, or the layer protecting the fetal spine. Some physicians use α-fetoprotein (AFP) to detect all cases of Spina Bifida, but it is difficult for all Spina bifida cases to be be found through AFP screening and amniocentesis. Due to a deficiency in screening, it is important to use sonography in the identification of the neurological condition.

Types of Spina Bifida

As mentioned above, Spina bifida is a type of NTD, in which the dorsal vertebrae fail to link resulting in a protrusion of both the spinal cord and its meninges. The lumber and sacral regions of the spinal cord are the most affected, hence are the most widespread causes of Spina bifida. There are three general categories of Spina bifida, which are Spina bifida occulta, Meningogecele and Myelomeningocele. Spina bifida occulta is the mildest and most common.

Illustration of Spina bifida occulta; Source: (Wingate et al., 2004, p. 229)

Spina bifida occulta is more widespread and does not have as many adverse effects as the two other forms of Spina bifida. In addition, Spina bifida occulta is more difficult to detect unless via an accidental X-ray. On the other hand, the more severe Spina bifida cases are not as common and are characterized by fluid leaks along the spinal cord wherein the fluid pushes up the skin causing the skin to protrude. These symptoms are inherent in the first severe type of spina bifida -- meningocele. The other type of severe case, myelomeningocele, affects the nervous system around the spine. The nerves get damaged resulting in inhibited movement, impaired coordination, and difficulty with bladder and bowel control.

Causes of Spina Bifida

It was shown that four children born in 1490 to women who were administered anticonvulsant agents when pregnant were diagnosed with spinal bifida. (Rosa 1991). The table below gives a summary of the 4 cases;

Table of Infants with Spina Bifida Born to Women Taking Antiepileptic Agents during Pregnancy

Drug No. of Spina Bifida Cases/no. of Pregnant Women on Drugs

Barbiturates 3/1058 1/1018

Phenytoin 1/469 0/444

Carbamazepine 3/107 2/99

Primidone 1/62 0/50

Valproic Acid 1/47 0/39

TOTAL 4/1490

(Rosa 1991)

The study above indicates that out of every 107 pregnant women who took carbamazepine, three children had Spina bifida. The intake of phenytoin, barbiturates, and primidone ( other anticonvulsion medications) do not directly cause Spina bifida.

The major challenge here is determining whether drug administration and its associated defect lies with the agent itself, or the prevailing circumstances under which the drug is being administered. This is due to the existing contrast between thee danger linked with susceptibility to either valproic acid or to carbamazepine. There was only a borderline risk of Spina bifida after the exposure in utero to antiepileptic agents other than valproic acid or carbamazepine (6 cases among 4489 exposures, relative risk 2.0; 95% confidence limits, 0.7 and 5.5)" (Rosa 1991). Research in Spina bifida shows that epileptic mothers and the administration of antiepileptic drugs are not concurrent with the risk of children with Spina bifida. Maternal genetic effects occur when a genetically mediated maternal phenotype influences the phenotype of offspring. The only exception is when that agent is carbamazepine or valproic acid. (Doolin, Barbaux and McDonnell 2002).

Studies on group of females taking carbamazepine when pregnant is consistent with the case reports from cohorts of Medicaid beneficiaries who are exposed to