Epilepsy in children with shunted hydrocephalus

Marie Bourgeois, Christian Sainte-Rose, Giuseppe Cinalli, Wirginia Maixner, Conor Malucci, Michel Zerah, Alain Pierre-Kahn, Dominique Renier, Elisabeth Hoppe-Hirsch, Jean Aicardi
1999 Neurosurgical Focus  
The incidence of epilepsy among children with hydrocephalus and its relation to shunts and their complications, raised intracranial pressure (ICP), and developmental outcome are explored in a retrospective study. The authors studied a series of 802 children with hydrocephalus due to varying causes, who were treated by ventriculoperitoneal shunt placement between 1980 and 1990, with a mean follow-up period of 8 years. Patients who had tumoral hydrocephalus and those whose files lacked
more » ... s lacked significant data were excluded. Data extracted from medical records, including history of the hydrocephalus and history of seizures, if any, were analyzed. Thirty-two percent of the children had epilepsy, the onset of which frequently occurred at approximately the same time that the diagnosis of hydrocephalus was made. The majority of the affected children had severe uncontrolled epilepsy. The incidence of epilepsy was significantly affected by the original cause of the hydrocephalus. The presence of radiological abnormalities was also found to be a significant predictor of epilepsy. Similarly, shunt complications predisposed to epilepsy. Episodes of raised ICP related to hydrocephalus or in association with shunt malfunction may also predispose to epileptic seizures. Furthermore, the presence of a shunt by itself seems able to promote an epileptogenic focus. Finally, epilepsy appears to be an important predictor of poor intellectual outcome in hydrocephalic children with shunts. A prospective study is needed to identify clearly and confirm avoidable factors predisposing to seizures in these children so that we can strive to reduce the incidence of these seizures and, subsequently, improve quality of life. Key Words * epilepsy * hydrocephalus * ventriculoperitoneal shunt Children requiring ventricular shunts have a higher incidence of seizures than the general population, varying from 6 to 59% in the reported literature. [2, 4, 5, 9, 11, 13, 15, 17, [22] [23] [24] [25] 29, [32] [33] [34] [35] There are many factors that may account for this, including the cause of the hydrocephalus, its subsequent treatment, and
doi:10.3171/foc.1999.6.2.4 fatcat:c2xpnzvf6ffwnnhnnofxdzlrya