title: Recurrence risks for neural tube defects in siblings of patients with lipomyelomeningocele.
abstract: OBJECTIVE
  Neural tube defects (NTDs) are a group of widely varying congenital malformations resulting from incomplete or improper fusion of the neural tube during embryonic development. NTDs are traditionally classified by the presence or absence of a layer of skin covering the spinal defect. Although a genetic component has been well established in the etiology of open NTDs, studies examining the genetics of closed NTDs such as lipomyelomeningocele are rare. We and others have previously observed families in which multiple members were affected with a broad spectrum of NTDs, suggesting the possibility of a common genetic etiology.
  
  
  METHODS
  We calculated the sibling recurrence risk in 52 pedigrees in which the proband was diagnosed with lipomyelomeningocele (LMM), defining recurrence broadly to include both closed and open neural tube defects.
  
  
  RESULTS
  Although no recurrences of LMM were observed among younger siblings, one younger sibling had myelomeningocele, yielding an estimate of recurrence risk of 0.04 (95% CI 0.01-0.20). When all siblings of the proband were included, two additional affected siblings were identified, one with anencephaly and another with fatty filum, yielding an estimate of recurrence risk of 0.043 (95% CI 0.01-0.12).
  
  
  CONCLUSIONS
  Although the sample size is small, these data are not inconsistent with recurrence risks for myelomeningocele, ranging from 2% to 5% in siblings. These data suggest the underlying genetic basis for closed defects may be the same or closely related to that for myelomeningocele in some families, although a larger sample will be necessary before these data are appropriate for use in a clinical setting. Further characterizations, including whether risk for recurrence of NTDs or LMM in families in which the proband is affected with LMM are altered by folate supplementation, may shed light on the underlying genetics.
authors.affiliation: Duke University Medical Center, Durham, North Carolina, USA.
authors.forename: Courtney Drake
authors.initials: CD
authors.lastname: Sebold
authors.forename: Elizabeth C
authors.initials: EC
authors.lastname: Melvin
authors.forename: Debbie
authors.initials: D
authors.lastname: Siegel
authors.forename: Lorraine
authors.initials: L
authors.lastname: Mehltretter
authors.forename: David S
authors.initials: DS
authors.lastname: Enterline
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Nye
authors.forename: John
authors.initials: J
authors.lastname: Kessler
authors.forename: Alexander
authors.initials: A
authors.lastname: Bassuk
authors.forename: Marcy C
authors.initials: MC
authors.lastname: Speer
authors.forename: Timothy M
authors.initials: TM
authors.lastname: George
mesh_terms: D016022:Case-Control Studies; D005260:Female; D020022:Genetic Predisposition to Disease / Q000235:genetics*; D005820:Genetic Testing; D006801:Humans; D008297:Male; D008591:Meningomyelocele / Q000235:genetics*; D009436:Neural Tube Defects / Q000235:genetics; D010375:Pedigree; D012307:Risk Factors; D035781:Siblings