THERAPEUTIC ASPECTS FOR FUNCTIONAL RECOVERY FROM PARAPLEGIA IN SPINA BIFIDA - BRIDGING THE CENTRAL-PERIPHERAL GAP

ABSTRACT Paraplegic status in patient with spina bifida (myeloschisis) remains for the entire life. It is now becoming more apparent that there are two contradictory therapeutic goals to be selected; termination of the pregnancy under the prenatal diagnosis, or radical surgical intervention to reconstruct the neural structures. In early 1980s, clinical application of nerve anastomosis in patients with spina bifida was reported by two authors (Epstein F. et al and Oi, S. et al), namely “Intercostal nerve lumbar nerve root anastomosis”. Regarding the basic aspects of neuronal stnuctures in dysraphism, the authors investigated the neuronal maturation process in dysraphic states both in the clinical examples and the experimental models. The results disclosed a fact that the neuronal development were not monotonously suppressed but partly overmatured. These disorderly developed neurons were diffusely identified in cephalic dysraphism, while the neural placode was the focus to grow such overgrown neurons in spinal dysraphism. Based on these results, a new experimental rat spina bifida model induced by vitamin A or high oxygen concentration was developed by using a wholeembryo culture technique, and a fetus-to-fetus spinal cord transplantation was performed to repair the congenital gap of the spinal cord neural networks in this model. From the knowledge obtained in these studies, it was emphasized that the neural reconstructive prcedure should be undertaken on the process of neuronal maturation, i.e. during the fetal period, in order to develop the proper neural networks and neural connections.