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Seizures in children with congenital hydrocephalus: long-term outcome
1Edward Mallinckrodt Department of Pediatrics, Washington University School of Medicine, St. Louis, MO 63110.
Insights
Children with congenital hydrocephalus and normal intelligence may safely discontinue antiseizure medication after 3 seizure-free years. Mental retardation is a key factor in predicting seizure recurrence.
Area of Science:
- Neurology
- Pediatrics
- Neurosurgery
Background:
- Congenital hydrocephalus is a condition affecting brain development.
- Seizures are a common complication in children with congenital hydrocephalus.
- Predictors for seizure occurrence and remission require further investigation.
Purpose of the Study:
- To investigate seizure occurrence and remission in children with congenital hydrocephalus.
- To identify factors influencing seizure control and medication discontinuation.
- To establish criteria for safely withdrawing antiseizure medication.
Main Methods:
- Retrospective review of 68 children with congenital hydrocephalus.
- Analysis of seizure occurrence, central nervous system (CNS) malformations, and mental retardation (MR).
- Evaluation of medication withdrawal in seizure-free patients.
Main Results:
- 48.5% of children experienced seizures; MR and CNS malformations correlated with occurrence.
- 14 out of 33 children with seizures had adequately controlled seizures on medication.
- Absence of MR and CNS malformations predicted seizure remission.
- Medication discontinuation was safe in seizure-free children with normal intelligence.
Conclusions:
- Congenital hydrocephalus management requires attention to seizure control.
- Normal intelligence and 3 years seizure-free on medication are indicators for safe medication withdrawal.
- MR is a significant predictor of seizure recurrence after medication cessation.
Abstract:
We documented seizures in 33 of 68 (48.5%) children with congenital hydrocephalus not associated with myelomeningocele. Mental retardation (MR) and CNS malformations correlated with seizure occurrence; age at shunt insertion and number of shunt revisions and infections were not significant variables in predicting seizures. Of 11 patients seizure free for 2 or more years on medication, six had therapy discontinued without seizure recurrence. Among those 33 children with seizures, 14 (42.4%), including five who had failed withdrawal of medication, have adequately controlled seizures on anticonvulsants. Frequent convulsions despite treatment occur in 13 (39.4%) of the 33 children with seizures. Absence of MR, older age and nonparoxysmal EEG at seizure onset, and absence of CNS malformation correlated with seizure remission. Longer time without seizures while on medication did not predict successful discontinuation of therapy. In contrast, MR correlated significantly with seizure recurrence following cessation of treatment. Our study indicates that medication can be safely discontinued in children with congenital hydrocephalus who are of normal intelligence and have been seizure free on anticonvulsants for 3 years.