Myelomeningocele: neglected aspects

Abstract

The commonest cause of neurogenic bladder in children is myelomeningocele. Survival of children is much improved in the Western world, but by 35 years old, about 50% will have died. In adults, the commonest causes of death are lung and heart diseases. All physical aspects deteriorate with age, especially in those with thoracic lesions. Those who walk in childhood have a 20-50% chance of becoming wheelchair dependent as adults. Immobility, poor respiratory reserve, obesity, latex allergy and worsening kyphoscoliosis contribute to the increased risks of surgery. It is essential that safe and manageable urine drainage is established in childhood: the bladder never improves with time, and surgical reconstruction becomes progressively more difficult. Independence in adult life will only be possible with intense preparation in childhood. Children must be allowed to join in with family chores and events. Education, both academic and practical, must be encouraged. Skills such as driving, shopping and birth control must be taught. However, even with the best support, less than 40% will have gainful employment. Children who are continent and have lesions below L2 are likely to have normal sexual function. Sexual activity in adolescents, especially in those with hydrocephalus, is limited (but not absent). However, by adult life, about two thirds will have established a regular partnership. All females and those males who are naturally potent are likely to be fertile. There is a high risk of neural tube defects in their offspring unless the female partner takes prophylactic folic acid for 3 months before pregnancy and for first trimester.

Fig. 1

Survival curve for children born with spina bifida

Fig. 2

Histogram to show the causes of death in children and adults born with spina bifida. CNS Central nervous system

Fig. 3

Percentage of children who start ambulation (with or without aids) and percentage who continue to walk up to 9 years 1 month, by spinal level [10]

Fig. 4

Clinical photograph to illustrate the difficulty that adults with spina bifida have in visualizing the lower half of the abdomen

Fig. 5

Histogram showing sexual activity in women with spina bifida [28]. SI Sexual intercourse

Fig. 6

Histogram showing sexual activity in men with spina bifida [28]. SI Sexual intercourse

Fig. 7

Graph showing the incidence of births of children with neural tube defects by year. The black line shows the sales of folic acid