BENGALURU : Have you seen children with an outgrown mass (exterior or interior) along the spinal cord or a child with abnormal size of the head? Well, these anomalies are basically associated with the abnormal development of the brain and the spinal cord. All these groups of anomalies have been clubbed together and termed as spina bifida, which means a stiff spinal cord. Invariably, the spina bifida, have been associated with excessive collection of fluid in the brain called hydrocephalus.
In a bid to generate awareness about this preventable and treatable condition, October 25 is observed as World Spina Bifida and Hydrocephalus Day. India has a huge epidemic of spina bifida and over 2 million children have died from anencephaly and spina bifida.
Brain development is a very complex process. During the first 28 days of intra uterine life, the embryo forms a shoot like plate called the neural plate which folds upon itself to form a tube called the neural tube. This tube starts closing from one end to the other end. The upper end expands to become the brain, while the lower part develops to become the spinal cord. During this process, if the neural tube does not close properly, the spine will remain open leading to a variety of anomalies such as spina bifida.
Spina bifida is broadly divided into two parts. One is called the spina bifida Manifesta, where the lesion is visible on the skin. If the lesion is not visible, then it is called spina bifida occulta.In case of spina bifida occulta, there could be a tug of war like situation called feathered cause syndrome where the spinal cord gets stuck below causing problem in the movement of spine resulting in tractional injury. This manifest itself in a variety of issues such as sensory loss and weakness in the leg, loss of control in urine and motion, deformity of spine and lack of sensation.
Diagnosis, prevention and treatment
Nowadays, majority of spina bifida can be diagnosed with a pre-natal screening and ultrasound. In case of a family history, mothers need to undergo intense screening. If such anomaly is detected early, the pregnancy can be terminated.
In case of spina bifida occulta, a good number of cases have been treated. When a child is born, a hole on dermal sinus or abnormal swelling needs to be checked, as these are a few of the indications of spina bifida occulta. This needs a proper evaluation with MRI and treated accordingly before the child develops any neurological problems. In severe anomalies, the child can have bone deformities, paralysis or deformity of ankle spine or also anomalies of the internal organs. If the anomalies are correctable, it needs to be done immediately.
Children may have enlarged head and the size keeps on increasing, indicating that there is collection of fluid (cerebo spinal fluid) in the ventricle and brain matter becomes thinner and thinner leading to intellectual deficiency and several other problems. If the head circumference is increasing beyond the normal limits, then one must go for a scan and identify the presence of the fluid. If the fluid is treated by surgical methods, then the child can have normal brain development. Most importantly, one needs to understand that spina bifida is preventable.
Associated risk factors for spina bifida and hydrocephalus are pregnancy in elderly women, smoking, certain medicines, infection, consanguineous marriage and genetic abnormality. An adequate use of folic acid by expectant mothers helps in preventing this serious anomaly. Hence, expectant mothers should take folic acid three months before they plan the pregnancy and continue 7.5 g of folic acid per day. It is known to reduce and prevent such anomalies.
Many countries have adopted folic acid fortification in diet as a preventive measure. Spina bifida occulta can be treated by neuro-surgery, which will help in releasing the spinal cord and reconstructing them, thereby enhancing them to grow normally.Brains is now coming up with a comprehensive spina bifida Hydrocephalus Clinic at its MVJ Hospital Centre.
The author is the founder and chief neurosurgeon, Brains Hospital