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Explain Neural Tube Defects – Part 2

Neural tube defects also abbreviated as NTDs are among the most common birth defects.

Overview of Neural Tube Defects

• Approximately one in 1,000 live births get affected with NTD in US.
• A NTD is usually an opening inside medulla spinalis or brain that occurs very early in human development.
• From the 3rd week of childbearing called gastrulation, specialized cells around the dorsal side in the fetus begin to fuse and form the neural tube.
• In the event of NTD, the neural tube does not close completely.

Folic Acid Pathway
Folacin (vitamin B9) and vitamin B12 are very important in reducing the occurrences of NTDs. Folate becomes necessary for:
– Production and upkeep of new cells
– For DNA synthesis
– RNA synthesis
• Folate can carry one carbon groups for methylation and nucleic acid synthesis.
• Many experts have hypothesized that this early human embryo could be particularly prone to folate deficiency on account of differences of the functional enzymes therein pathway during embryogenesis coupled with high demand for post translational methylations in the cytoskeleton in neural cells during neural tube closure.
• Vitamin B12 can be a vital receptor within the folate biopathway.
• This is shown in studies that deficiency in vitamin B12 plays a part in risk of NTDs.
• Importantly, a lack of folate itself does not cause neural tube defects.
• The association seen between reduced neural tube defects and vitamin M supplementation is caused by exposing folate-dependent NTDs, like from the Splotch gene mutation.
• Therefore, giving vitamin B supplementation while being pregnant cuts down on the prevalence of NTDs by not exposing this otherwise sub-clinical mutation.
• Not all mutations are folate-dependent though.

Other Causes
Other potential causes can include:
– folate antimetabolites
– maternal diabetes
– maternal obesity
– mycotoxins in contaminated corn meal
– arsenic
– hyperthermia during the early development
– radiation
• Research has shown that both maternal tobacco use and maternal exposure to secondhand smoke increased the chance for neural tube defects in offspring.
• A mechanism in which maternal contact with cigarettes could increase NTD risk in offspring is mandatory.
• This is proven by a number of studies that demonstrate a connection between smoking and homocysteine levels.
• Case study shows that cigarette, including secondhand exposure, isn’t just hazardous towards mother, but also can affect neural tube closure inside the developing embryo.

Detection for Neural Tube Defects

Tests for neural tube defects include:
– Ultrasound examination
– Measurement of maternal serum alpha-fetoprotein (MSAFP)
– Amniotic fluid alpha-fetoprotein (AFAFP)
– Waters acetylcholinesterase (AFAChE)
• These are also employed to confirming if ultrasound screening indicates having a positive risk.
• These defects are prominent at birth.
• Occult defects can be left un-diagnosed until much later in life.
• A rapid MSAFP measured at 16–18 weeks gestation is a superb predictor of neural tube defects.

Prevention for Neural Tube Defects

• The US Food and Drug Administration employed regulations in 1996 which requires fortifying vitamin M to grain products. They are like:
– enriched breads
– cereals
– flour
– other grain products
• You will need to be aware that throughout the first 4 weeks of pregnancy, adequate folate intake is critical for proper operation of the neurulation process.
• Therefore, ladies who could conceive are encouraged to eat foods fortified with folic acid or take supplements besides eating folate-rich foods to relieve the risks of serious birth defects.
• In Canada it is mandatory to fortify selected foods with folate.
• Studies have revealed the incidence of neural tube defects reduced by 46% due to intake of folate.
• Women that are pregnant really should get 400 micrograms of vitamin M daily.
• Girls that are pregnant should receive 1.0 mg daily, and some women who may have previously given birth with a child having a neural tube defect should get 4.0 mg/5.0 mg in England mg daily.

Treatment for Neural Tube Defects

• Treatments of NTDs are based on the severity of the reason underlying.
• No medication is designed for anencephaly because the infants tend not to survive more than a few hours.
• Aggressive surgical management has improved survival and also the functions of infants with schistorrhachis, meningoceles and mild myelomeningoceles.
• The achievements surgery often depends on the volume of brain tissue mixed up in encephalocele.
• The goal of treatment for NTDs is usually to let the individual to offer the highest a higher level function and independence.

Tethered Cord Syndrome in Children and Adults Principles and Practice of Pediatric Neurosurgery Neural Tube Defects: From Origin to Treatment

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