Controversies in the treatment of neural tube defects with neurological deterioration

✍ Scribed by Liptak, Gregory S.

• Publisher: John Wiley and Sons
• Year: 1998
• Tongue: English
• Weight: 82 KB
• Volume: 4
• Category: Article
• ISSN: 1080-4013
• DOI: 10.1002/(sici)1098-2779(1998)4:4<296::aid-mrdd9>3.0.co;2-u

✦ Synopsis

A significant portion of children who have meningomyelocele deteriorate neurologically. Based on a review of the literature published since 1966, a mean of 14% develop symptoms of Chiari II malformation, while 11% develop signs of tethered spinal cord. However, the care of these individuals is controversial for several reasons. First, standards for clinical criteria to diagnose these conditions have not been established. Second, the natural history of untreated children is generally unknown. Third, the majority of studies dealing with these issues have not used sound methodology. For example, studies on patients who have cerebral palsy and cystic fibrosis published since 1966 were almost twice as likely to meet criteria for randomized trials than studies on meningomyelocele. Therefore, evidence-based recommendations for clinical care are difficult to make. Future research in these areas should be planned, prospective, and methodologically sound. Collaboration among researchers should be encouraged by national and international organizations. Until these changes occur, controversies will remain and care will be less than optimal.

1998 Wiley-Liss, Inc.