Does spina bifida affect the brain
Spina bifida - Symptoms - NHS
Spina bifida can cause a wide range of symptoms, including problems with movement, bladder and bowel problems, and problems associated with hydrocephalus (excess fluid on the brain).
The severity of the symptoms of spina bifida varies considerably, largely depending on the location of the gap in the spine.
A gap higher up the spine is more likely to cause paralysis of the legs and mobility difficulties compared with gaps in the middle or at the base of the spine, which may only cause continence issues.
A baby is more likely to have learning difficulties if they develop hydrocephalus.
Movement problems
The brain controls all the muscles in the body with the nerves that run through the spinal cord. Any damage to the nerves can cause problems controlling the muscles.
Most children with spina bifida have some degree of weakness or paralysis in their lower limbs. They may need to use ankle supports or crutches to help them move around. If they have severe paralysis, they'll need a wheelchair.
Paralysis can also cause other, associated problems. For example, as the muscles in the legs are not being used regularly, they can become very weak.
The muscles support the bones so muscle weakness can affect bone development. This can cause dislocated or deformed joints, bone fractures, misshapen bones and an abnormal curvature of the spine (scoliosis).
Bladder problems
Many people with spina bifida have problems storing and passing pee. This is caused by the nerves that control the bladder not forming properly. It can lead to problems such as:
- urinary incontinence
- urinary tract infections (UTIs)
- hydronephrosis – where one or both kidneys become stretched and swollen due to a build-up of pee inside them
- kidney scarring
- kidney stones
The bladder and kidneys will need to be regularly monitored because of the risk of infection.
Ultrasound scans may be needed, as well as tests to measure the bladder's volume and the pressure inside it.
Bowel problems
The nerves that run through the spinal cord also control the bowel and the sphincter muscles that keep poo in the bowel.
Many people with spina bifida have limited or no control over their sphincter muscles and have bowel incontinence.
Bowel incontinence often leads to periods of constipation followed by episodes of diarrhoea or soiling.
Hydrocephalus
Some babies with spina bifida have hydrocephalus (excess fluid on the brain), which can damage the brain and cause further problems.
Many people with spina bifida and hydrocephalus will have normal intelligence, although some will have learning difficulties, such as:
- a short attention span
- difficulty solving problems
- difficulty reading
- difficulty understanding some spoken language – particularly fast conversations between a group of people
- difficulty organising activities or making detailed plans
They may also have problems with visual and physical co-ordination – for example, tasks such as tying shoelaces or fastening buttons.
In some babies the lower parts of the brain are pushed downwards towards the spinal cord. This is known as type 2 Arnold-Chiari malformation and is linked to hydrocephalus.
Hydrocephalus can cause additional symptoms soon after birth, such as irritability, seizures, drowsiness, being sick and poor feeding.
Read more about the symptoms of hydrocephalus.
Other problems
Other problems associated with spina bifida include:
- skin problems – reduced sensation can make it difficult to tell when the skin on the legs has been damaged – for example, if the skin gets burnt on a radiator; if a person with spina bifida injures their legs without realising, the skin could become infected or an ulcer could develop; it's important to check the skin regularly for signs of injury
- latex allergy – people with spina bifida can develop an allergy to latex; symptoms can range from a mild allergic reaction – watery eyes and skin rashes – to a severe allergic reaction, known as anaphylactic shock, which requires an immediate injection of adrenalin; tell medical staff if you or your child is allergic to latex
Page last reviewed: 20 April 2020
Next review due: 20 April 2023
Spina Bifida Health Issues and Treatments
No two people with spina bifida are exactly alike.
Health issues and treatments for people with spina bifida will be different for each person. Some people have issues that are more severe than other people. Those born with “open” spina bifida usually have more health issues and need more types of treatments.
In addition to the information below, the Spina Bifida Association has written guidelines for spina bifida careexternal icon.
- Open Spina Bifida
- Hydrocephalus
- Tethered Spinal Cord
- Mobility and Physical Activity
- Mobility and Physical Activity
- Using the Bathroom
- Skin Care
- Latex (Natural Rubber) Allergy
- Health Checks
- Other Concerns
- References
Open Spina Bifida
Sometimes when a baby has open spina bifida, or myelomeningocele, doctors will perform surgery to close the spine before the baby is born.
This surgery is a major procedure for the mother and the baby, and may not be available where you live.
Contact a doctor who works regularly with spina bifida babies and expectant mothers about the pros and cons of this option. The Spina Bifida Association offers information for expectant parents.external icon
Hydrocephalus
Many babies born with spina bifida get hydrocephalus (often called water on the brain). This means that there is extra fluid in and around the brain. The extra fluid can cause the spaces in the brain, called ventricles, to become too large and the head can swell. Hydrocephalus needs to be followed closely and treated properly to prevent brain injury.
If a baby with spina bifida has hydrocephalus, a surgeon can put in a shunt. A shunt is a small hollow tube that will help drain the fluid from the baby’s brain and protect it from too much pressure. Additional surgery might be needed to change the shunt as the child grows up or if it becomes clogged or infected.
For more information, please visit the Hydrocephalus Associationexternal icon website
Spina Bifida Association fact sheet
Hydrocephalus and Shuntsexternal icon
Tethered Spinal Cord
Many people with open spina bifida have tethered spinal cords.
Normally, the bottom of the spinal cord floats around freely in the spinal canal. A tethered spinal cord is attached to the spinal canal. When this happens, the spinal cord stretches as a person grows, which can permanently damage the spinal nerves. The person might have back pain, scoliosis (crooked spine), leg and foot weakness, changes in bladder or bowel control, and other problems. A tethered spinal cord can be treated with surgery.
For more information, please visit the Spina Bifida Association website:
Spinal Cord Tetheringexternal icon
Mobility and Physical Activity
People affected by spina bifida get around in different ways. These include walking without any aids or assistance; walking with braces, crutches or walkers; and using wheelchairs.
People with spina bifida higher on the spine (near the head) might have paralyzed legs and use wheelchairs. Those with spina bifida lower on the spine (near the hips) might have more use of their legs and use crutches, braces, or walkers, or they might be able to walk without these devices.
Regular physical activity is important for all people, but especially for those with conditions that affect movement, such as spina bifida. CDC recommends 60 minutes of physical activity a day. There are many ways for people with spina bifida to be active. For example, they can:
- Engage in active play with friends.
- Roll or walk in the neighborhood.
- Participate in community programs, such as the Early Intervention Program for Infants and Toddlers with Disabilities and Special Education Services for Preschoolers with Disabilities, which are free programs in many communities.
- Enjoy parks and recreation areas with playgrounds that are accessible to people with disabilities.
- Do exercises recommended by a physical therapist.
- Attend summer camps and recreational facilities that are accessible for those with disabilities.
- Participate in sports activities (for example, swimming) and teams for people with or those without disabilities.
For more information, please visit the following websites:
Hip Functionexternal icon
Early Intervention Programs for Infants and Toddlers
National Center on Health, Physical Activity and Disability (NCHPAD)- Spina Bifida Guidelinesexternal icon
Adaptive Physical Education Disabled Sports USAexternal icon
Using the Bathroom
People with spina bifida often cannot control when they go to the bathroom (incontinence). They also can develop urinary tract infections. It is important to develop a plan for going to the bathroom that works and is as simple as possible. This can lead to increased health, participation, and independence, and avoid embarrassment for people with spina bifida. Healthcare providers can help develop a plan for each person. A tube (catheter) inserted in the bladder can help drain urine. In some cases, extra fiber can be added to the diet to keep bowel movements regular. Surgery also might be recommended.
For more information, please visit the Spina Bifida Association website:
Urologic Care and Managementexternal icon
Skin Care
Children and adults living with spina bifida may have limited feeling in some areas of their body, leaving them unable to feel cuts, bruises, sores, and dry skin. Since a person with spina bifida may not know they have been hurt, they may be unable to tell a parent or caregiver that they need help.
Pressure sores occur when there is prolonged pressure on soft tissue, skin, and muscle. Healthcare professionals report skin wounds as one of the primary diagnoses associated with the hospitalization1 of people with spina bifida. Pressure sores can lead to infection, amputation, or even death.
By checking skin regularly for redness including under braces, people with spina bifida, along with their parents and caregivers, can identify skin problems before they become pressure sores.
Additional ways to protect the skin:
- Avoid hot bath water, heaters, hot dishes, hot car seats, and metal seatbelt clasps, since they may cause burns.
- Make sure you are wearing properly fitting shoes at all times, even when swimming.
- Use sunscreen, and don’t stay out in the sun too long.
- Do not sit or lie in one position for too long.
Did You Look?
The Spina Bifida Association created the Did You Look? materials to help patients maintain healthy skin. These materials were written by age and are available in English and Spanish.
Please see links below:
Poster (English) pdf icon[2.15 MB / 1 page]external icon
Infant Brochure (English) pdf icon[752 KB / 2 pages]external icon
School Age Brochure (English) pdf icon[536 KB / 2 pages]external icon
Adolescent/Adult Brochure (English) pdf icon[593 KB / 2 pages]external icon
Poster (Spanish) image icon[JPG]external icon
Infant Brochure (Spanish) pdf icon[741 KB / 2 pages]external icon
School Age Brochure (Spanish) pdf icon[525 KB / 2 pages]external icon
Adolescent/Adult Brochure (Spanish) pdf icon[584 KB / 2 pages]external icon
Reference
- Dicianno BE, Wilson R. Hospitalizations of adults with spina bifida and congenital spinal cord anomalies. Archives of Physical Medicine and Rehabilitation 2010 Apr;91(4):529-35.
Latex (Natural Rubber) Allergy
Many people with spina bifida are allergic to products that contain latex, or natural rubber. This means they should not use items made of natural rubber. For babies, this would include rubber nipples and pacifiers. A person with this type of allergy can wear a bracelet to alert other people of the allergy.
For more information, please visit the Spina Bifida Association website:
Latex (Natural Rubber) Allergy in Spina Bifidaexternal icon
Health Checks
Every person needs a primary care provider, such as a pediatrician, nurse practitioner, general family doctor, or internist. The primary care provider will want to make sure that he or she is healthy; developing normally; and receiving immunization against diseases and infections, including the flu.
In addition to seeing a primary health care provider, a person with spina bifida will be checked and treated as needed by doctors who specialize in different parts of the body. These doctors might suggest treatments or surgeries to help the person.
These specialists might include:
- An orthopedist, who will work with muscles and bones.
- A urologist, who will check the kidneys and bladder.
- A neurosurgeon, who will check the brain and spine.
Other Concerns
Some people with spina bifida have difficulty with:
- Learning
- Relating to others
- Vision
- Staying at a healthy weight
- Depression
References
Sandler, Adrian, M.D.(2004). Living with Spina Bifida: A Guide for Families and Professionals. University of North Carolina Press: Chapel Hill.
Merkens, Mark J., M.D. and the Spina Bifida Association’s Professional Advisory Council (2006). Guidelines for Spina Bifida Health Care Services Throughout the Lifespan. Third Edition. Spina Bifida Association.
Primary Children’s Medical Center (2008). Let’s Talk about Spina Bifida.
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Spina bifida (spina bifida) - treatment, symptoms, causes, diagnosis
Spina bifida (spina bifida) is a complex congenital defect in the development of the spinal cord and spine. This is a type of open neural tube defect in which there is an abnormal development of the back of the spine, the spinal cord, the surrounding nerves, and/or the fluid-filled sac that surrounds the spinal cord.
Spina bifida (back bifida) is an incurable, life-long condition that affects the neuromuscular and musculoskeletal systems.
This defect varies by type and ranges from moderate to severe.
Children with this defect may need corsets as the body grows, and in severe cases, a wheelchair.
Treatment is mainly aimed at slowing down the deformity and maintaining motor activity.
The defect may occur along the entire length of the spine and may present as part of the spinal cord and surrounding tissues protruding outward rather than inward. Approximately 85 percent of defects occur in the lower back and 15 percent in the neck and thoracic region. Surgically, it is possible to restore the integrity of the spinal column, but nerve damage cannot be restored, and if they are pronounced, then patients have various degrees of paresis of the lower extremities. The higher the defect on the spinal column, the more severe the nerve damage and movement disorders (paresis and paralysis).
According to studies, this developmental anomaly occurs in 7 cases per 10,000 newborns. There are several types of spina bifida that have varying degrees of severity.
- Latent spina bifida (spina bifida occulta) - the most moderate form, in which there are no obvious signs of malformation and changes in the skin. In this form, at least one vertebra changes, but the nerves and spinal cord do not bulge. A child at birth may have a spot or depression in the area of the anomaly. And usually, the baby will not have symptoms. With this form of anomaly (as well as with others), there may be an anomaly in the development of the spinal cord, characterized by attachment of the spinal cord to the spine to the end of the lumbar region, when normally the spinal cord ends at the level of the first lumbar vertebrae and sags freely without attachment to the spine.
- Meningocele is a moderate (and the most common) anomaly in which the spinal canal is not properly closed and the meninges (membranes that cover the spinal cord) bulge outside the bony structures of the spinal canal, but the spinal cord itself remains intact. The cystic mass is covered with skin. Most children with meningocele have normal limb function, but may have partial paresis or abnormalities of the bladder or bowel. With this anomaly, there is often underdevelopment of the spinal cord. Almost all patients with this anomaly require surgery to close the defect and free the spinal cord.
- Lipomeningocele is an anomaly in which fatty tissue is attached to the spinal cord and puts pressure on it. Children with this form of anomaly may not have severe nerve damage, but bladder and bowel function may be impaired. In these cases, surgical treatment is also often used.
- Myelomeningocele: the most severe common form and associated with spina bifida. The spinal canal is not closed, and the bulging mass consists of the meninges, pathologically altered spinal cord, and nerves.
In addition, in this area the skin is also underdeveloped. In children with this form of spinal cord splitting, paresis below the defect and dysfunction of the pelvic organs are observed in whole or in part. In addition, nerve damage and other pathologies are observed.
Symptoms
The symptoms of spina bifida vary greatly, depending on the form and severity of the individual child. For example, at birth:
- In latent splitting (spina bifida occulta), there may be no obvious signs or symptoms—only a small spot, depression, or birthmark.
- With a meningocele, there will be a sac-like protrusion that will be located on the back in the spinal region.
- With myelomeningocele, there will also be a protrusion, but with altered skin, there will be a release of nerves and spinal cord.
In severe spina bifida with localization in the lumbar spine, the following symptoms may occur: paralysis of the lower extremities, dysfunction of the bladder, intestines. In addition, these patients usually have other developmental anomalies:
- Hydrocephalus occurs in 75 percent of myelomeningocele cases and this condition requires operative endoscopic treatment in order to restore normal CSF flow or a shunt to drain excess fluid from the brain.
- Chiari anomaly (displacement of the brain into the upper cervical vertebrae) can cause pressure on the brainstem, which can manifest as impaired speech, swallowing, and motor disorders in the limbs.
- Underdevelopment of the spinal cord Orthopedic problems including scoliosis, kyphosis, hip dysplasia (congenital dislocation), combined deformities, clubfoot, etc.
- Precocious puberty (especially in girls with spina bifida and hydrocephalus).
- depression and other neurotic conditions
- obesity
- dermatological problems
- developmental anomalies of the urinary tract.
- heart disease
- vision problems
Diagnosis
Diagnosis may be performed during pregnancy to evaluate the fetus for spina bifida. These include:
- Amniocentesis: A procedure in which a long, thin needle is inserted through the mother's abdomen into the amniotic sac to remove a small amount of amniotic fluid for examination. The fluid is analyzed to determine the presence or absence of an open neural tube defect. Although the analysis is very reliable, it does not allow diagnosing small or closed defects.
- Prenatal ultrasound: this technique, being absolutely harmless, allows you to non-invasively assess the condition and visualize the internal organs, vessels, tissues of the fetus. Sometimes it is possible to diagnose not only spina bifida, but also other anomalies.
- Blood tests: It is recommended that blood tests be performed between 15 and 20 weeks of gestation for all women who have not previously had a child with an open neural tube defect and who have no family history of the condition. A blood test for alpha-fetoprotein and other biochemical parameters can determine how high the risk of developing spinal anomalies is.
- At birth, severe cases of spina bifida are evident by the presence of a fluid-filled sac bulging on the back of the newborn. Visual indicators of mild forms (spina occulta) may be a hairy patch on the skin or a depression along the spine. Unusual weakness or lack of coordination in the lower extremities also suggests spina bifida. In children and adults, this anomaly is often diagnosed during routine studies or, if necessary, to differentiate neurological symptoms using instrumental research methods (MRI, CT, radiography).
Causes
During pregnancy, the human brain and spinal column begin to form as a flat sheet of cells that folds into a tube called the neural tube. If all or part of the neural tube fails to close, then the open area is called an open neural tube defect. An open neural tube is open in 80 percent of cases, and is covered by bone or skin in 20 percent of cases. The cause of spina bifida (spina bifida and other defects) remains unknown, but is most likely the result of a combination of genetic, nutritional, and environmental factors, such as:
- maternal dietary deficiency of folic acid (vitamin B) during pregnancy (sufficient folic acid intake during pregnancy may reduce the risk of this anomaly).
- maternal uncontrolled diabetes
- Certain medicines (antibiotics, anticonvulsants).
- A genetic factor is usually only relevant in 10 percent of cases.
- Mother's age
- What kind of births on the account (firstborns are more at risk).
- Socioeconomic status (children born in lower socioeconomic families are at higher risk).
- ethnicity
- obesity or excessive consumption of alcohol by a pregnant woman
- When exposed to pregnant hyperthermia in the early stages (sauna, jacuzzi).
Treatment
Spina bifida can be treated immediately after birth. If this defect is diagnosed prenatally, then a caesarean section is recommended in order to reduce possible damage to the spinal cord during the passage of the birth canal. Newborns with meningocele or myelomeningocele are recommended to have surgery within 24 hours of birth. With such an operation, the bone defect is closed and it is possible to preserve the function of the intact part of the spinal cord. Unfortunately, surgical treatment cannot restore the function of damaged nerves as they are irreversible.
Currently, there are clinics that perform prenatal surgery to close the defect, but the techniques have not yet found wide application. The main task of treatment, both in a non-severe form and in the postoperative period, is to preserve the functions of both the musculoskeletal system and the functions of the bladder and intestines. If necessary, orthoses, therapeutic exercises, physiotherapy are used.
In cases where spina bifida is detected by chance during X-ray (MRI, CT) examination, measures must be taken to reduce the risk of spinal cord injury in the area of the spine where this defect exists.
Operative treatment in adults is used only in the presence of complications. Basically, treatment in adults is aimed only at preventing possible complications (exercise therapy, physiotherapy, wearing a corset).
Spina bifida and how to treat it?
15. 07.2021
Spina bifida (spina bifida) is a developmental defect of the spine that occurs as early as the third week of fetal life and consists in incomplete closure of the spinal canal. The dorsal 9 can come out of this free space.0117 brain with meninges or meninges themselves (meningeal hernia ). What are the causes of spina bifida ? How is the treatment and rehabilitation of patients with spawning eggs divided in half?
Spina bifida - what is it?
Spina bifida, also known as meningeal hernia or bisected scar, is a birth defect that occurs in approximately 2.5% of live newborns. There is a violation of the formation of structures of the spinal brain and spine . It occurs in utero around the third week of pregnancy (although it is most often detected with high accuracy in the second trimester when seen on ultrasound ) and may appear along the entire length of the spine . The most common localization of hernia is the lumbar or lumbosacral segment (spina bifida L5 - S1). In about 75% of cases, this defect is accompanied by congenital hydrocephalus.
As a result, nerve conduction to various parts of the body is disturbed. We can also deal with the latent cleft, which the patient learns about in adulthood, because it is so limited and asymptomatic that it does not affect the functioning of the body.
The cause of this malformation of the spine is not fully understood. On the one hand, experts talk about genetic determinants and inheritance, on the other hand, about external phenomena, such as infections in the womb, deficiency of folic acid and B vitamins, exposure of pregnant women to X-rays, anticonvulsants.
Spina bifida - types of spina bifida
There are three main types of spina bifida: a bunch of hair, often the patient is not aware of the defect because there are no symptoms;
Spina bifida - symptoms
Spina bifida is often a tumor of various sizes on the back covered with thin skin. Sometimes only a depression or dimple, hair spot, bump, or red mole is found.
Depending on the type of cleft and the degree of its occurrence, one can speak of various clinical symptoms. The more the cleft appears in the lower back and the less widespread it is, the better the child will live a normal life. However, one should always remember that a child with spina bifida has several health problems related to different organs.
The most common symptoms of spina bifida include paresis of the limbs, forcing them to move in a wheelchair. Another problem is uneven circulation of cerebral fluid, which requires the position of the valve, as well as dysfunction of the urinary system. With a cleft located in the lumbosacral region, paresis or paralysis of the muscles of the lower extremities is flaccid, the position of the feet may be clubfoot, sphincter disorders lead to incontinence urine , and sensory disturbances are of the root type. In the case of a cleft, sensory disturbances located in the cervical or thoracic region are of the spinal type, and the lower limbs are of the pyramidal type. It happens that the symptoms of some meningeal hernias may not appear until ectopic development.
Spina bifida with age leads to such consequences of the disease as spinal curvature , hip dislocation , muscle contractures and deformities bones and joints .
Spina bifida - treatment
Spina bifida is often diagnosed during pregnancy based on fetal ultrasound. The diagnosis is confirmed by the analysis of amniotic fluid.
After birth or while still in the womb (antenatal surgery ), your baby will have surgery to close hernia and reduce the risk of infection. Most often it is carried out in the first two days of life. Since this defect causes irreversible damage nervous system and various related problems, the child needs specialized care neurologist , orthopedist , urologist , physiotherapist and psychologist .
