Macrocephaly in children with developmental disabilities
Yoram Nevo1, Uri Kramer, Shlomo Shinnar
1Institute for Child Development and The Pediatric Neurology Unit, Division of Pediatrics, Dana Children's Hospital, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Insights
Macrocephaly, or large head size, in children with developmental disabilities significantly increases the risk of seizures, even without hydrocephalus. This finding highlights macrocephaly as a key indicator for seizure risk in this population.
Area of Science:
- Pediatric Neurology
- Developmental Pediatrics
- Clinical Epidemiology
Background:
- Macrocephaly is defined as head circumference above the 98th percentile for age.
- The association between macrocephaly and neurodevelopmental outcomes requires further investigation, particularly in children without hydrocephalus.
Purpose of the Study:
- To investigate the association between macrocephaly and various neurodevelopmental disabilities and outcomes in a pediatric cohort.
- To determine if macrocephaly, independent of hydrocephalus, is a risk factor for specific developmental issues and seizures.
Main Methods:
- Community-based study of 4,309 children referred to a developmental institute.
- Prevalence calculation of macrocephaly (1.4%) and macrocephaly without hydrocephalus (1%).
- Statistical analysis to assess macrocephaly as a risk factor for febrile seizures, epilepsy, mental retardation, and cerebral palsy.
Main Results:
- Macrocephaly was a significant risk factor for febrile seizures (OR=3.1) and epilepsy (OR=7.7) in children with developmental disabilities.
- Macrocephaly was not significantly associated with mental retardation (OR=1.1) or cerebral palsy (OR=1.3).
- Children with macrocephaly exhibited a high rate of comorbid diagnoses.
Conclusions:
- In children with developmental disabilities, macrocephaly is an independent risk factor for seizures, including epilepsy.
- The presence of macrocephaly warrants careful monitoring for seizure activity, even in the absence of hydrocephalus.
- Macrocephaly is associated with increased seizure risk in children with neurodevelopmental disabilities.
Abstract:
In a community-based study of 4,309 children with neurodevelopmental disabilities who were referred to the Institute for Child Development, Tel Aviv, Israel, 62 (1.4%) had macrocephaly (head circumference above the ninety-eighth percentile for age), of whom 42 (1%) had macrocephaly not associated with hydrocephalus. With the exception of neonatal respiratory distress the incidence of perinatal complications was not different from that in other children referred to the Institute for Child Development. In children with developmental disabilities, macrocephaly was a significant risk factor for febrile seizures (odds ratio = 3.1, P < 0.001) and epilepsy (odds ratio = 7.7, P < 0.001), but not for mental retardation (odds ratio = 1.1, P = 0.78) or cerebral palsy (odds ratio = 1.3, P = 0.67). Children with macrocephaly had a high rate of comorbid diagnosis. We conclude that in children with developmental disabilities the presence of macrocephaly even when not associated with hydrocephalus is associated with an increased risk of seizures.
