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We read with interest the results of Huntet al in their long term follow up of spina bifida survivors with intraventricular shunts.1 In 48 shunt treated adult patients, they find that 27.1% (13 patients) live independently, 35.4% (17 patients) drive a car and 25% (12 patients) are in open employment. They also report that those requiring shunt revision, particularly after 2 years of age, have lower levels of achievement as defined by these three criteria. Overall, 22.9% (11 patients) are “community walkers”.
The clinic for adults with spina bifida and hydrocephalus (CASBAH) in Belfast receives referrals on a regional and non-selective basis from paediatric services after the age of 16 years. Of those currently attending the clinic, 95 are shunt treated survivors. There are 50 men and 45 women, average age 25.6 years (range 16–39 years). Fifty three patients (55.8%) are wheelchair dependent, 7 (7.4%) are largely wheelchair dependent but retain some ambulatory capacity, 18 (18.9%) are ambulatory with aid, and 17 (17.9%) are independently ambulatory. Overall 35/95 (36.8%) can be considered “community walkers”.
Of 61 patients in whom complete data are available, 22 (36.1%) are in full or part-time employment, 10 (16.4%) are students (six of these in higher/further education), three (4.9%) are in fully fledged training schemes, two receive sheltered training, and 24 (39.3%) are unemployed. Twenty patients (32.7%) are regular drivers and a further two (3.3%) are actively learning to drive. Eight patients are married (13.1%) and three are parents (4.9%). In five patients (8.2%), epilepsy is an active problem.
Our data therefore suggest a rather more optimistic outcome in terms of mobility and employment for long term shunt treated survivors of spina bifida. Interestingly, and again by contrast with the data of Huntet al, these figures differ little from those for our whole clinic population, shunt and non-shunt treated survivors, where 34% are in employment, 33% are unemployed, 32% are regular drivers, 17% are married or engaged, 8% are parents, and 8% have epilepsy.2 Although it is possible that the more severely affected shunt treated patients simply did not survive into adulthood, thereby causing an intrinsic bias, these figures would indicate that the presence of a shunt and the potential for subsequent revision has rather less of an impact on prognosis than is suggested by their paper.
We would, however, agree with their conclusion that ease of access to a neurosurgical unit is essential for infants and children with spina bifida. We would further recommend that this continues in adulthood as seven of our patients have required surgical intervention for a Chiari/hydrosyringomyelia complex at that stage, another shunt related complication.3