MENINGOMYELOCELE AND APPROACH TO THE PATIENT WITH MENINGOMYELOCELE

Meningomijelocela (MMC) kao najučestaliji i najteži oblik poremećaja zatvaranja neuralne cijevi je poseban zdravstveni problem. Iako ima relativno malu pojavnost u odnosu na neka druga oboljenja sa sobom donosi cjeloživotne poteškoće i potrebu za habilitacijom. Etiološki mehanizmi defekata neuralne cijevi (DNC-a) nisu u potpunosti razjašnjeni, a multifaktorski utjecaj s isprepletanjem genskih i okolišnih čimbenika najuvjerljivije je objašnjenje. Klinička slika koja uvelike ovisi o razini oštećenja i veličini same cistične tvorbe onemogućuje stvaranje nekakve „univerzalne“ terapije. Standardizirana metoda je operacijski zahvat koji se izvodi unutar 72h od poroda, a oštećenje motorike koje zaostaje tretira se fizioterapijskim metodama, prvenstveno stavljajući naglasak na Bobath i Vojta koncept koji kao smjernice u terapiji koriste normalan neuromotori razvoj djeteta. Glavni cilj i jednog i drugog koncepta je osposobljavanje pacijenta za svakodnevne aktivnosti, stavljajući naglasak na holistički pristup. MMC zahtijeva timski pristup u kojem će biti uključeni ginekolog, opstetričar, pedijatar neonatolog, neurokirurg, neuropedijatar, nefrolog, fizijatar, fizioterapeut, ortoped, logoped, defektolog, senzorni terapeut, psiholog, radni terapeut, itd. Potrebno je istaknuti da uz adekvatnu habilitaciju i dobru edukaciju osobe s MMC, njene obitelji i društva oko nas o važnosti ovog problema možemo puno učiniti kako bi osoba bila što više uključena u društveni život.Meningomyelocele (MMC) as the most common and the most severe form of neural tube closure defects is a particular health problem. Although it has a relatively small incidence compared to other malformations, it brings with it life-long difficulties and the need for habilitation. Etiological mechanisms of neural tube defects (DNCs) are not fully clarified, and the multifactorial effect of intertwining the genetic and environmental factors is the most convincing explanation. A clinical picture that largely depends on the level of damage and the size of the cystic form itself makes it impossible to create some "universal" therapy. The standardized method is an operation that is performed within 72h of the birth and the underlying motor damage is treated by physiotherapeutic methods, primarily by emphasizing the Bobath and Vojta concept that as a guideline in therapy use normal neuromotor development of the child. The main goal of both concepts is to train the patient for everyday activities, emphasizing holistic approaches. MMC requires a team approach involving gynecologists, obstetricians, pediatric neonatologists, neurosurgeons, neuropediatrist, nephrologists, physicians, physiotherapists, orthopedists, speech therapists, psychologists, work therapists, etc. It should be pointed out that with adequate habilitation and good education of the person with MMC, her family and society around us about the importance of this problem we can do a lot to make a person more involved in social life