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BioMed Central
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Cerebrospinal Fluid Research
Open Access
Poster Presentation
Evolution of neural function in spina bifida occulta and aperta
D Sival*, O Brouwer, A Staal-Schreinemachers, P Sauer and A de Vylder
Address: University Hospital, Groningen, Netherlands
Email: D Sival* - dasival@hotmail.com
* Corresponding author
Background
Spina bifida often results in dysfunction of the central and
peripheral nervous system. In spina bifida, the neural tube
defect may be covered by skin (SBO) or open (SBA). Fetal
surgery in SBA aims to preserve central axonal projections
through the meningomyelocele (MMC) and to prevent
secondary damage. The present study aimed to determine
whether the natural coverage of the neural tube defect in
SBO protects central axonal conduction, as could be
measured by vesico-urodynamics.
Objective
To compare central and peripheral neural innervation
between SBO and SBA in a longitudinal fashion.
Design/Methods
17 SBO and 16 SBA children were investigated at ages 1
and 2–4 years. In both groups the defect was at L3
(median value, range resp. L1-S1 (SBO), and Th12-S1
(SBA)). In all children, spinal segments S2-S4 (innervat-
ing anal and bladder reflexes) were located caudal to the
defect. Central dysfunctional bladder innervation was
defined as overactive detrusor or pelvic muscle activity
during vesico-urodynamics. Absence of anal reflexes indi-
cated peripheral neural dysfunction. Surgical detethering
was electively performed.
Results
Only in 1 of 17 SBO children detrusor activity became
overactive between year 1 and 2–4. The percentage of chil-
dren with overactive detrusor activity declined signifi-
cantly (P < 0.01) between years 1 and 2–4, both in SBO
(from 47% to 23%) and in SBA (from 79% to 38%). Sim-
ilarly the percentage of children with hyperactive pelvic
muscle activity declined significantly (P < 0.025) in SBO
(from 69% to 20%) and in SBA (from 67% to 45%). At
neither time point, the percentages were significantly dif-
ferent between SBO and SBA. Concerning LMN dysfunc-
tion however, a larger fraction of SBA children had
absence of anal reflexes, compared with SBO (86% vs.
31%, P < 0.005).
Conclusions
1. Natural covering of the spinal defect in SBO compared
with SBA is not associated with improved central innerva-
tion of the bladder; 2. Signs of central bladder dysfunction
decline in both SBA and SBO children between age 1 and
2–4 years; 3. Peripheral innervation is better preserved in
SBO than in SBA, by a mechanism independent of central
innervation.
from 48th Annual Meeting of the Society for Research into Hydrocephalus and Spina Bifida
Dublin, Ireland, 23–26 June 2004
Published: 23 December 2004
Cerebrospinal Fluid Research 2004, 1(Suppl 1):S55 doi:10.1186/1743-8454-1-S1-S55
<supplement> <title> <p>48th Annual Meeting of the Society for Research into Hydrocephalus and Spina Bifida</p> </title> <note>Meeting abstracts</note> </supplement>
This article is available from: http://www.cerebrospinalfluidresearch.com/content/1/S1/S55