PERINATAL MOTOR BEHAVIOR AND NEUROLOGICAL OUTCOME IN SPINA-BIFIDA APERTA

Aim of the study: In the present longitudinal study we investigated th e relationship between prenatal motor behaviour and the postnatal neur ological sequelae of infants with spina bifida aperta. Methods and pat ients: Prenatal isolated leg movements and general movements of 13 fet uses/infants with spina bifida aperta were assessed by means of ultras ound recordings, and were compared with: 1. the spinal level of morpho logical defect (meningo-myelocele), 2. the postnatal motor behaviour, 3. the postnatal sensory function, and 4. the final motor outcome. Res ults: In all 13 cases studied, the spinal defect was either at thoraci c (n = 8) or at lumbal (n = 5) level. All fetuses displayed active leg movements corresponding to the functioning of low lumbal myelum segme nts (L4-5 in two cases or L5-S1 in 11 cases), despite vertebral defect s at high localisation. These leg movements were of normal quality (no rmal in appearance) and endogenously generated, since no external stim ulus was exerted to elicit them. This implies that in fetuses with spi na bifida aperta active leg movements can be generated at spinal segme nts which are located at (n = 1), or under (n = 12) the meningo-myelel ocele. Postnatally, for a short period of time (mostly during the firs t few hours), leg movements related to myelum function at (n = 1) or l ower than (n = 7) the spinal defect were detected. However, only in tw o infants these early leg movements were of normal quality and corresp onded with the final motor outcome. In contrast to these early neonata l leg movements, early sensory function was strongly related to the sp inal defect (r = 0.76; P = 0.005) and to the final motor outcome (sens ory function predicted outcome in all infants of whom follow-up was pe rformed). Conclusion: These data on fetuses/infants with spina bifida aperta strongly indicate that a discrepancy exists between the occurre nce of prenatal leg movements and the spinal localisation of the menin go-myelocele on the one hand, and between the occurrence of pre-and po stnatal leg movements on the other hand (quantity and quality). (C) 19 97 Published by Elsevier Science Ireland Ltd.