Epilepsy in shunt‐treated hydrocephalus

Abstract

"c*rr' JS /) oiicfetice tojirst cirrtborcit Univcrsitnctsklinikiim Essen, Kindcrklinik. I lufcl;indhtr. 55.1)-45 122 Esscn.(krmany. tiAlthough epilepsy is commonly associated with shunt-treated hydrocephalus, its relation to the shunting procedure and the criteria identifying postoperative epilepsy remain controversial. Of 283 patients shunted at Wurzburg Univeixity Hospital over a 24-year period (1970 to 1994), 182 were followed up for a minimum of 1 year after shunt .insertion and entered the study. The data were analyzed retrospectively in 1995 aud 1996. Epilepsy was analyzed in relation to the etiology of hydrocephalus. functional status, time and site of shunt insertion, onset of seizures and seizure type, EEG changes, sex, shunt systems, and shunt revisions. Of the 182 patients studied, 37 (20%) developed epilepsy. The incidence of epilepsy varied according to the etiology of hydrocephalus: posthemorrhagic (5% 1, postinfectious (4%), connatal/miscellaneous/unknown (3% 1, myelomeningocele (2% ), tumor/arachnoidal cgstlaqueduct stenosis (0%).Early shunting and poor functional status was associated with a higher risk for epilepsy. Epilepsy was not influenced by sex, shunt systems, or number of shunt revisions. Twenty-two (12%) of 182 patients developed epilepsy (generalized N=13, focal N=9) after intracranial shunting. Focal EEG abnormalities (N=16) were located mainly at the anatomical site of the shunt (N=14), but only three patients (2%) presented with focal seizures contralateral and focal EEG abnormalities ipsilateral to the site of the shunt. The presence of epilepsy was determined by the etiology of hydrocephalus rather than by surgical intervention. The incidence of postoperative epilepsy (12%) was low. Onset of epilepsy, clinical presentation of seizures, and EEG changes did not appear to be valid criteria for identifying shunt-related epilepsy. Thus, epilepsy as a complication of intracranial shunting might be overestiniated in the literature.Epilepsy is reported to be conimonly associated with shunttreated hydrocephalus (Hosking 197 Method Bctwcen 1970 and 1994, 283 children with hydrocephalus undcnvcnt intnventricular shunting at \Vuriburg Ilniversiiy Hospital. One hundred and eighty-two patients who had initial shunting at this hospital were studied and follow-up was done in the outpatient clinic by a senior neuropediatrician (MB) for :it least 1 year (range 1 to 2 1 years).'I'he datx were anal!xd for ( 1) etiology ofhydrocephalus; Followv-up assessnicnts were scheduled for twice a year unless complications demanded niorc frequent assessments. Parents or carL.givcrs were instructed to observe and record seizures, and seizures were evaluated by nruropediatricians (IMB, I I-MS) as obscmcd and described by parents and medical staff during hospital admissions. EliGs were not taken routinely, but in each cliild who developed seizures, subsequent EliGs were obtained and a n n l p t l in our clinic.

Patterns in neurosurgical adverse events: cerebrospinal fluid shunt surgery

“…The risk of seizure as a result of shunt placement itself, however, is controversial. 6,48,74 Some work has suggested that frontal rather than parietal bur-hole placement was associated with increased incidence of seizure, 16 though these data have not been corroborated by other studies. 63,79,88 Thus perioperative seizures related to shunt placement are not an independent complication of surgery but warrant discussion given that they are common and can be problematic.…”

Epidemiology, Prevention and Management of Ventriculoperitoneal Shunt Infections in Children

“…Seizures in patients with hydrocephalus are common (patients with 1 or more event: 6–59%). Patients with epilepsy quite frequently present shunt malfunction and VPS infection in combination with seizures [48,49]. …”

Hydrocephalus in Early Childhood

“…Şant takılmış çocuklarda nöbet sıkça gelişebilmekte-dir [31][32][33] . Fransa'da ventriküloperitoneal şant ile tedavi edilen 802 çocuğu kapsayan bir çalışmada sekiz yıllık takip sonucunda %32 oranında epilepsi geliştiği rapor edilmiştir 33 .…”