| Postnatal management and outcome for neural tube defects including spina bifida and encephalocoeles. |
Thompson DN. (2009) Postnatal management and outcome for neural tube defects including spina bifida and encephalocoeles. Prenatal Diagnosis. Apr;29(4):412-9.
Department of Neurosurgery, Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London WC1N 3JH, UK.
This e-mail address is being protected from spambots. You need JavaScript enabled to view it
The incidence of neural tube defects (NTDs) has declined in recent decades, however myelomeningocele and encephalocele still represent one of the commoner prenatally diagnosed congenital malformations. Improved perinatal and post natal care mean that the mortality associated with these conditions has also fallen. Advances in the multidisciplinary management of children with myelomeningocele have led to significant improvements in functional outcome for many with this condition. However, there remains a substantial population of patients born with NTDs whose life expectancy is substantially reduced and who suffer significant cognitive and physical disability remaining wholly or partially dependant on the care of others into adult life. This article aims to outline the contemporary early management of these conditions and examine the prospects for functional outcome where possible, attempting to show how early anatomical features of these conditions can help predict where, along the wide spectrum of outcome, a given individual may lie.
PMID: 19194999 |
|
| The prevalence and predictors of anencephaly and spina bifida in Texas. |
Canfield MA, Marengo L, Ramadhani TA, Suarez L, Brender JD, Scheuerle A. The prevalence and predictors of anencephaly and spina bifida in Texas. Paediatric and Perinatal Epidemiology. 2009 Jan;23(1):41-50.
Birth Defects Epidemiology and Surveillance Branch, Texas Department of State Health Services, Austin, TX, USA.
Texas shares a 1255-mile border with Mexico and encompasses a variety of ecosystems, industries and other potential environmental exposures. The Texas Birth Defects Registry is an active surveillance system which covers all pregnancy outcomes (livebirths, fetal deaths and elective pregnancy terminations). This study describes the occurrence and the predictors of neural tube defects (anencephaly and spina bifida) in Texas between 1999 and 2003. Birth prevalence, crude and adjusted prevalence ratios and 95% confidence intervals were calculated using Poisson regression, for each defect, by fetal/infant sex, delivery year and maternal sociodemographic characteristics. Among approximately 1.8 million livebirths, a total of 1157 neural tube defects cases were ascertained by the Registry, resulting in an overall prevalence of 6.33 cases per 10 000 livebirths. The prevalences of anencephaly and spina bifida were 2.81 and 3.52 per 10 000 livebirths respectively. Prevalences of both defects were highest in Hispanics, among mothers living along the border with Mexico, among women of higher parity and among mothers who were 40+ years of age. In addition, |
|
| Urban-rural residence and the occurrence of neural tube defects in Texas, 1999-2003. |
Luben TJ, Messer LC, Mendola P, Carozza SE, Horel SA, Langlois PH. Urban-rural residence and the occurrence of neural tube defects in Texas, 1999-2003. Health Place. 2009 Sep;15(3):848-54. Epub 2009 Feb 23.
US Environmental Protection Agency, 109 T.W. Alexander Drive, Mail Drop B-243-01, RTP, NC 27711, USA.
Neural tube birth defects (NTDs) affect more than 4000 pregnancies in the US annually. The etiology of NTDs is believed to be multifactorial, but much remains unknown. We examined the pattern and magnitude of urban-rural variation in anencephaly, spina bifida without anencephaly, and encephalocele in Texas in relation with urban-rural residence for the period 1999-2003. There was no evidence that urban-rural residence was associated with changes in the rate of anencephaly or spina bifida without anencephaly in unadjusted or adjusted analyses. In contrast, rates of encephalocele were statistically significantly higher in areas classified as suburban or more rural compared to urban areas using four different urban-rural residence indicators.
PMID: 19299192 |
|
| Anencephaly and spina bifida among Hispanics: Maternal, sociodemographic, and acculturation factors in the National Birth Defects Prevention Study. |
Canfield MA, Ramadhani TA, Shaw GM, Carmichael SL, Waller DK, Mosley BS, Royle MH, Olney RS; The National Birth Defects Prevention Study. Anencephaly and spina bifida among Hispanics: Maternal, sociodemographic, and acculturation factors in the National Birth Defects Prevention Study. Birth Defects Research Part A; Clinical and Molecular Teratology. 2009 Mar 30.
Birth Defects Epidemiology and Surveillance Branch, Texas Department of State Health Services, Austin, Texas.
BACKGROUND: We used data from the multisite National Birth Defects Prevention Study for expected delivery dates from October 1997 through 2003, to determine whether the increased risk in anencephaly and spina bifida (neural tube defects (NTDs)) in Hispanics was explained by selected sociodemographic, acculturation, and other maternal characteristics.
METHODS: For each type of defect, we examined the association with selected maternal characteristics stratified by race/ethnicity and the association with Hispanic parents" acculturation level, relative to non-Hispanic whites. We used logistic regression and calculated crude odds ratios (ORs) and their 95% confidence intervals (CIs).
RESULTS: Hispanic mothers who reported the highest level of income were 80% less likely to deliver babies with spina bifida. In addition, highly educated Hispanic and white mothers had 76 and 35% lower risk, respectively. Other factors showing differing effects for spina |
|
| Are birth defects among Hispanics related to maternal nativity or number of years lived in the United States? |
Ramadhani T, Short V, Canfield MA, Waller DK, Correa A, Royle M, Scheuerle A; National Birth Defects Prevention Study (NBDPS). Are birth defects among Hispanics related to maternal nativity or number of years lived in the United States? Birth Defects Research Part A; Clinical and Molecular Teratology. 2009 Apr 6. [Epub ahead of print]
Birth Defects Epidemiology and Surveillance Branch, Texas Department of State Health Services, Austin, Texas.
BACKGROUND: Literature on the risk of birth defects among foreign- versus U.S.-born Hispanics is limited or inconsistent. We examined the association between country of birth, immigration patterns, and birth defects among Hispanic mothers.
METHODS: We used data from the National Birth Defects Prevention Study and calculated odds ratios (ORs) and 95% confidence intervals and assessed the relationship between mothers" country of birth, years lived in the United States, and birth defects among 575 foreign-born compared to 539 U.S.-born Hispanic mothers.
RESULTS: Hispanic mothers born in Mexico/Central America were more likely to deliver babies with spina bifida (OR = 1.53) than their U.S.-born counterparts. Also, mothers born in Mexico/Central America or who were recent United States immigrants ( |
|
| Comparing Outcomes of Slings With Versus Without Enterocystoplasty for Neurogenic Urinary Incontinence. |
Snodgrass W, Keefover-Hicks A, Prieto J, Bush N, Adams R. Comparing Outcomes of Slings With Versus Without Enterocystoplasty for Neurogenic Urinary Incontinence.
Journal of Urology. 2009 Apr 16.
Pediatric Urology Section, University of Texas Southwestern Medical Center at Dallas and Children"s Medical Center.
PURPOSE: We compared 2 cohorts of children with neurogenic urinary incontinence undergoing bladder neck sling with and without augmentation to determine relative continence outcomes, catheterization intervals, anticholinergic requirements and health related quality of life improvement as perceived by the patients and their parents.
MATERIALS AND METHODS: Consecutive patients followed through our spina bifida program underwent a structured postoperative interview by a research nurse to assess continence, interval between catheterizations and anticholinergic use. In addition, the child and parent together answered a health related quality of life satisfaction survey to determine the impact of surgery from their perspectives.
RESULTS: There were 18 patients undergoing sling with augmentation and 23 with sling alone. Overall improved continence rate was 83%, with no difference between outcomes in patients with vs without augmentation. However, the interval between catheterizations was longer and the use of anticholinergics was less following augmentation. Nevertheless, health related quality of life responses |
|
| From neuromuscular activation to end-point locomotion: An artificial neural network-based technique for neural prostheses. |
Chang CL, Jin Z, Chang HC, Cheng AC. From neuromuscular activation to end-point locomotion: An artificial neural network-based technique for neural prostheses. Journal of Biomechanics. 2009 Apr 21. [Epub ahead of print]
Department of Physical Medicine & Rehabilitation, School of Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA.
Neuroprostheses, implantable or non-invasive ones, are promising techniques to enable paralyzed individuals with conditions, such as spinal cord injury or spina bifida (SB), to control their limbs voluntarily. Direct cortical control of invasive neuroprosthetic devices and robotic arms have recently become feasible for primates. However, little is known about designing non-invasive, closed-loop neuromuscular control strategies for neural prostheses. Our goal was to investigate if an artificial neural network-based (ANN-based) model for closed-loop-controlled neural prostheses could use neuromuscular activation recorded from individuals with impaired spinal cord to predict their end-point gait parameters (such as stride length and step width). We recruited 12 persons with SB (5 females and 7 males) and collected their neuromuscular activation and end-point gait parameters during overground walking. Our results show that the proposed ANN-based technique can achieve a highly accurate prediction (e.g., R-values of 0.92-0.97, ANN (tansig+tansig) for single composition of data sets) for altered end-point |
|
| Why IQ is not a covariate in cognitive studies of neurodevelopmental disorders. |
Dennis M, Francis DJ, Cirino PT, Schachar R, Barnes MA, Fletcher JM. Why IQ is not a covariate in cognitive studies of neurodevelopmental disorders. Journal of the International Neuropsychological Society. 2009 May;15(3):331-43.
Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada.
This e-mail address is being protected from spambots. You need JavaScript enabled to view it
IQ scores are volatile indices of global functional outcome, the final common path of an individual"s genes, biology, cognition, education, and experiences. In studying neurocognitive outcomes in children with neurodevelopmental disorders, it is commonly assumed that IQ can and should be partialed out of statistical relations or used as a covariate for specific measures of cognitive outcome. We propose that it is misguided and generally unjustified to attempt to control for IQ differences by matching procedures or, more commonly, by using IQ scores as covariates. We offer logical, statistical, and methodological arguments, with examples from three neurodevelopmental disorders (spina bifida meningomyelocele, learning disabilities, and attention deficit hyperactivity disorder) that: (1) a historical reification of general intelligence, g, as a causal construct that measures aptitude and potential rather than achievement and performance has fostered the idea that IQ has special status and that in studying neurocognitive function in neurodevelopmental disorders; (2) IQ does not meet the requirements for a |
|
| Tethered cord release: a long-term study in 114 patients. |
Bowman RM, Mohan A, Ito J, Seibly JM, McLone DG. (2009) Tethered cord release: a long-term study in 114 patients. Journal of Neurosurgery Pediatrics. 2009 Mar;3(3):181-7.
Division of Pediatric Neurosurgery, Children"s Memorial Hospital, Chicago, USA.
This e-mail address is being protected from spambots. You need JavaScript enabled to view it
OBJECT: All children born with a myelomeningocele at the authors" institution undergo aggressive treatment to maintain or improve functional outcome. Consequently, when any neurological, orthopedic, and/or urological changes are noted, a search for the cause is initiated. The most common cause of decline in a child born with a myelomeningocele is shunt malfunction. The second most common cause is tethering of the distal spinal cord at the site of the original back closure. In this report, the authors review the indicators of symptomatic spinal cord tethering and discuss the surgical interventions and outcomes in the children with myelomeningocele who underwent treatment at Children"s Memorial Hospital from 1975 to 2008.
METHODS: Among the 502 children who underwent original closure at Children"s Memorial Hospital, a symptomatic tethered spinal cord developed in 114 (23%). Eighty-one patients (71%) have undergone 1 untethering procedure, and 33 patients (29%) have undergone multiple untetherings, for a total of 163 total surgeries. The indicators of symptomatic spinal cord tethering include scoliosis, decline in lower-extremity (LE) motor strength, |
|
| Motor profile and cognitive functioning in children with spina bifida. |
Vinck A, Nijhuis-van der Sanden MW, Roeleveld NJ, Mullaart RA, Rotteveel JJ, Maassen BA. Motor profile and cognitive functioning in children with spina bifida.
European Journal of Pediatric Neurology. 2009 Feb 21. [Epub ahead of print]
Department of Medical Psychology, Radboud University Nijmegen Medical Centre, The Netherlands; Department of Paediatric Neurology, Radboud University Nijmegen Medical Centre, The Netherlands.
BACKGROUND: Spina bifida is a complex neuroembryological disorder resulting from incomplete closure of the posterior neural tube. Morbidity in the different fields of motor and cognitive neurodevelopment is variable in nature and severity, and often hard to predict.
AIMS: The current study investigates the relationship between cognitive functioning, fine motor performance and motor quality in children with spina bifida myelomeningocele (SBM) and SB-only, taking into consideration the cerebral malformations.
MATERIAL AND METHODS: Forty-one children were included (22 girls and 19 boys aged between 6 and 14 years, mean age 10;0 years) in the study. A comprehensive assessment was conducted of cognitive functioning and motor profile, including fine motor and visual-motor functioning, and motor quality. The performance outcomes were analyzed for the total group of children and separately for the nonretarded children (FSIQ>/=70, N=30) to eliminate the influence of global intellectual impairment. |
|
|
|
