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Prognosis for seizure control and remission in children with myelomeningocele
1Edward Mallinckrodt, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO 63110.
Insights
Children with myelomeningocele experience seizures, but most achieve seizure control and remission. Mental retardation is linked to seizures, yet long-term outcomes remain positive, with many children discontinuing anti-epileptic drugs.
Area of Science:
- Pediatric Neurology
- Developmental Neuroscience
Background:
- Myelomeningocele is a complex congenital condition often associated with neurological complications.
- Seizures are a known complication in children with myelomeningocele, impacting quality of life and management.
Purpose of the Study:
- To determine the incidence of seizures in children with myelomeningocele.
- To evaluate seizure control, remission rates, and predictors of long-term outcomes in this population.
Main Methods:
- A combined retrospective and prospective study design.
- Inclusion of 140 children diagnosed with myelomeningocele.
- Analysis of seizure incidence, medication management, and associated factors like hydrocephalus and mental retardation.
Main Results:
- Seizure incidence was 16.5% in patients with hydrocephalus and 19.4% without.
- Mental retardation and cerebral malformations were more common in children with seizures.
- Three-quarters of patients with seizures discontinued anti-epileptic medication without recurrence; five had well-controlled seizures.
Conclusions:
- Children with myelomeningocele have a high likelihood of achieving seizure control and remission.
- Mental retardation is the primary predictor of long-term outcomes.
- Prognosis for seizure management in myelomeningocele is generally excellent, with potential for medication discontinuation.
Abstract:
A combined retrospective and prospective study was designed to determine the incidence of seizures in 140 children with myelomeningocele, as well as the potential for seizure control and remission. The incidence of seizures in 109 patients with myelomeningocele and hydrocephalus was 16.5 per cent, and 19.4 per cent in a further 31 patients without hydrocephalus. Mental retardation, often in combination with cerebral malformations, was significantly more common in children with seizures, regardless of presence or absence of hydrocephalus. Of the 24 patients with convulsion, three-quarters had anti-epileptic medication discontinued, without recurrence of seizures. An additional five children's seizures are well controlled with medication. Mental retardation was the only significant predictor of long-term outcome. These results indicate that children with myelomeningocele have an excellent prognosis for seizure control and subsequent remission off medication.
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