The nervous system is one of the first components that begin to develop during our development, when we are still fetuses. Throughout the first month of pregnancy, in fact, already the neural tube that will configure our brain begins to close and spinal cord.
These will be surrounded and protected by the skull and spine. However, in some cases a malformation occurs that prevents the neural tube and the spinal column from closing, remaining open to some degree so that the nerve bundles it contains can suffer various damages and injuries. We are talking about spina bifida.
We understand spina bifida a type of malformation produced during fetal development in which part of the neural tube does not close completely during the first month of pregnancy, so that the spinal column does not fully protect the nerves that go down through it and the spinal cord is exposed to injuries and damage of varying severity. Sometimes this opening is visible, although in other cases it is hidden by the skin.
Spina bifida may not generate symptoms in some cases, but depending on the type of malformation, its location and the existence of possible damage to it, severe dangerous problems can be generated for the subject. The closer the opening is to the brain, the greater the severity of the symptoms as a greater number of nerves are damaged.
Some of the typical symptoms of subjects with spina bifida, specifically due to the presence of lesions in the spinal cord due to this malformation, may be the presence of gastrointestinal disorders, lack of control of the sphincters and urethra, weakness and lack of sensitivity of the lower limbs or the areas located below the injury and it is even possible that there is total paralysis of these areas.
It must be taken into account that in some cases the opening of the neural tube is very close to the skull and that it can generate alterations such as hydrocephalus or meningitis, with a risk of mortality for the affected person. Learning problems and even intellectual disabilities may occur in some cases.
Types of spina bifida
Spina bifida is a problem that can present in different ways, so it is possible to establish different subtypes based on its characteristics.
1. Occult spina bifida
This is the form of presentation with the least repercussions for the subject, and it is the most common form of manifestation of spina bifida.
In this case one or more vertebrae have not formed correctly and may have openings, although the nervous tissue remains inside. The malformation is hidden by skin. The subject may have pits or bumps on the back. It does not usually cause serious disabilities, but there may be deformities, incontinence, numbness in some of the extremities or weakness.
2. Cystic or open spina bifida
In this type of spina bifida, part of the spinal cord or the meninges protrude outside the vertebrae, having a high level of danger for the subject who suffers from it as the nervous material protrudes and is not protected. Are They usually form a sac filled with cerebrospinal fluid and the outstanding material that can be observed externally.
Within this type we can find two subtypes.
Meningocele
In this case we find a malformation in which the meninges of the spinal cord protrude, the lesion may be exposed or protected by the skin. However, what protrudes is only the meninges and cerebrospinal fluid, with the nerve bundles still inside the spine.
This is the most severe form of spina bifida. In it the cord is exposed and protrudes through the opening of the spine. In other words, the nerve fiber bundles do not have bone protection, but are exposed on the outside of the spinal column. It can lead to serious paralysis that prevents bipedal locomotion and loss of sensitivity and strength of the innervated areas.
The possible causes
spina bifida It is a congenital condition, although not hereditary. Although the elements and mechanisms that cause the neural tube to fail to close are unknown, it is an alteration that occurs during the individual’s fetal development, and is usually associated with the presence of low levels of folic acid during pregnancy. . There is also speculation about the possibility that there is some type of genetic influence.
There are other elements that can be risk factors such as the use of certain psychotropic drugs during pregnancy (for example valproic acid), the presence of high fevers during pregnancy or the age at which pregnancy begins (adolescents and very old people may be at greater risk).
Treatment
Spina bifida is a disorder that It does not have a completely curative treatment, at least as far as damaged nerves are concerned. However, it is possible to perform various types of surgery that allow the neuronal matter to be relocated and protected.
In the case of subjects with occult spina bifida, treatment may not be necessary (in fact, in many cases it is not detected until advanced ages). Although there may be spinal anchoring problems that can cause problems during growth. In this case, yes surgery would be necessary.
In cases of open or cystic spina bifida, an intervention is necessary. In the case of myelomeningocele, it is necessary close the tube and protect the neuronal bundles. Currently it is possible to perform the intervention even in the fetal stage, so that the problem is corrected before delivery in such a way that more damage than already exists is avoided, although these are treatments that can pose a certain danger to both the fetus as for the mother.
Other spine or bone problems derived from spina bifida may require treatments and surgeries beyond those described above. In cases with hydrocephalus, excess cerebrospinal fluid must also be treated.
Prevention in pregnancy
Another way to avoid this problem is through prevention. It is recommended that during pregnancy the future mother incorporates folic acid into her diet or take supplements of it.
Special caution is necessary with adolescent or very elderly mothers, and in the case of an epileptic person who takes valproic acid, they should consult with their doctor or psychiatrist about the possible effects of this medication or the possibility of using other anticonvulsants as an alternative.
