Epilepsy in children with shunted hydrocephalus

Object. 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. Methods. The authors studied a series of 802 children with hydrocephalus du e to varying causes, who were treated by ventriculoperitoneal shunt placeme nt between 1980 and 1990, with a mean follow-up period of 8 years. Patients who had tumoral hydrocephalus and those whose files lacked significant dat a 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 frequen tly occurred at approximately the same time that the diagnosis of hydroceph alus was made. The majority of the affected children had severe uncontrolle d epilepsy. The incidence of epilepsy was significantly affected by the ori ginal cause of the hydrocephalus. The presence of radiological abnormalitie s was also found to be a significant predictor of epilepsy. Similarly, shun t 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. Conclusions. 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, improv e these children's quality of life.