Your foetus’s brain and spinal cord are developed from a structure called the neural tube. This tube usually closes 28 days after conception. However, for some babies, the bottom end of the tube — near the lower back — fails to fuse, resulting in spina bifida.
The condition is detected in routine blood tests and ultrasounds during the first trimester, followed by another ultrasound or an MRI-scan to confirm it.
“Patients with a myelomeningocele will have life-long health issues such as lower limb paralysis and loss of sensation, as well as bladder and bowel dysfunction.”
Dr Darryl Lim, a paediatrician at Mount Alvernia Hospital’s Kinder Clinic, explains that there are three forms of this potentially devastating congenital condition:
* Spina Bifida Occulta Marked by a gap in the back bone, patients are usually unaware of the defect until it’s been uncovered incidentally through X-ray or scanning. This occurs in about two to three per cent of births here.
* Meningocele The tissues covering the spinal cord — called meninges — bulges through the gap in the backbones but does not affect the nerves or spinal cord. This bulge can be seen on the surface of baby’s skin and can be as small as a grape or as large as a grapefruit. Surgery can repair the defect with minimal to no damage to the spinal cord or nerves, says Dr Lim.
* Myelomenigocele In this most severe form of the condition, the meninges and spinal cord protrude outside the spinal cord. The exposed parts may be covered by a thin membrane or completely exposed to the outside. Prompt surgery is often needed after birth.
Dr Lim adds that the risk of developing spina bifida — specifically meningocele or myelomeningocele — is higher when one’s sibling is affected by it.
Incidentally, a child with myelomeningocele can also face life-long developmental issues. Dr Lim notes, “Patients with a myelomeningocele will have life-long health issues such as lower limb paralysis and loss of sensation, as well as bladder and bowel dysfunction.”
To lessen the chances that their babies suffer from this condition, mums-to-be should takes sufficient folic acid supplements during the early part of their pregnancy.
Dr Lim answers your questions about myelomenigocele…
Can surgery drain the fluid collected in the spinal cord?
As myelomeningocele may be associated with hydrocephalus and the excess fluid can exert pressure on the brain, the doctor may need to insert a ventriculo-peritoneal shunt — a medical device used to relieve pressure on the brain caused by built-up fluid. The shunt will help to drain the spinal fluid from the brain to the abdomen. Over time, these shunts can become [blocked] or infected. Hence, surgery may be needed to reinsert it.
What other complications does myelomeningocele cause?
The extent of nerve damage depends on the size and location of the defect, and which spinal nerves protrude outside the spinal canal. That said, some of the problems that may arise include the following:
* Hydrocephalus Babies may have an accumulation of fluid in the brain, known as hydrocephalus. These babies will need a surgical operation to insert a tube to drain fluid from the brain into their abdomen.
* Meningitis Some babies may not have a covering over the protruding sac, hence leaving their nerves and spinal cord exposed. These babies may develop an infection of the protective membranes covering the brain and spinal cord called meningitis. Such infections may be life-threatening and can result in long term neurological problems.
* Paralysis of the lower limbs This can be partial or complete depending on the level of the defect and which nerves protrude. Such patients will eventually need crutches to walk, braces to strengthen their legs or a wheelchair for mobility.
“Some of these patients may also develop learning difficulties — mainly, issues with concentration or problems with language and reading.”
* Loss of sensation Your mini-me’s lower limbs have to be constantly monitored for pressure sores or undetected injury as they have no sensation there. The skin on the affected areas will require constant care and protection. Pressure sores have to be treated early with appropriate dressings and antibiotics to prevent further breakdown or infection of the wounds.
* Problems with bladder control If the nerves that control the bladder are affected, patients will have problems storing urine in the bladder, emptying the bladder properly, or both. A tube will be inserted into the patient’s bladder to drain urine regularly through the day. This will reduce the pressure in the bladder and kidneys and prevent urinary tract infections.
* Problems with bowel control Constipation may also result because the nerves that regulate the bowel may be affected. They may require the help of laxatives, enemas or suppositories to help them pass stools regularly.
What treatments are there?
Treatment for myelomeningocele depends on its complications. For instance, patients with hydrocephalus usually need a shunt to be inserted. Urinary tract infections may also happen frequently, so oral or intravenous antibiotics will be needed.
Is lifelong medication or therapy necessary?
Again, treatment or medication may be lifelong depending on the complications. Some of these patients may also develop learning difficulties — mainly, issues with concentration or problems with language and reading. They may require some form of therapy to help overcome these difficulties.
Main photo: iStock
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