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Primary Prevention of Neural Tube Defects

Neural tube defects (NTDs) are one of the commonest malformations seen in pediatric surgical practice.They form a spectrum of disease ranging from anencephaly to spina bifida occulta. NTDs are devastating conditions as most of the lesions (myelomeningoceles, myelocele etc.) are always associated with neurological deficits producing varying degree of limb paresis/paralysis, bladder and anorectal incontinence. A significiant number also have or later on develop hydrocephalus with its attendant complications following shunt surgery. Thus NTDs offer a tremendous challenge in management, that requires the co-ordination and co-operation of many specialists with an aim to rehabilitate and integrate these handicapped patients with a satisfying life in to the society. This may be an ideal and true situation in the West but in a developing country like India, it is a difficult task as most of the patients are poor and their number is so large requiring huge resources for their treatment and rehabilitation. In the given scenario, the emphasis should on antenatal prevention, diagnosis and treatment and in postnatal period on selective management.