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Seizures in relation to shunt dysfunction in children with meningomyelocele
C H Hack1, B G Enrile, J F Donat
1Department of Pediatrics, Handicapped Child Clinic, Columbus, Ohio.
Insights
Seizures are not a reliable indicator of increased intraventricular pressure in children with hydrocephalus and meningomyelocele. While seizures can occur, they often present with other symptoms of shunt dysfunction.
Area of Science:
- Pediatric Neurosurgery
- Neurology
Background:
- Hydrocephalus and meningomyelocele are common conditions in children.
- Shunt-dependent hydrocephalus requires careful monitoring for complications.
Purpose of the Study:
- To evaluate seizures as a predictive symptom of increased intraventricular pressure (IVP) in children with shunt-dependent hydrocephalus and meningomyelocele.
Main Methods:
- Retrospective chart review of 346 patients.
- Analysis of 129 admissions for shunt dysfunction in 51 patients with seizures.
- Correlation of seizure episodes with shunt dysfunction indicators.
Main Results:
- Nine out of 101 admissions (9%) for increased IVP included seizures as a presenting symptom.
- All nine seizure episodes were accompanied by other common symptoms of shunt dysfunction.
- Seizures alone were not the sole indicator of increased IVP.
Conclusions:
- Seizures are an unreliable standalone predictor of shunt dysfunction and increased IVP in this patient population.
- Seizures may be one of several presenting symptoms of shunt malfunction.
Abstract:
To determine whether seizures are a reliable sign of increased intraventricular pressure in children with shunt-dependent hydrocephalus and meningomyelocele, we performed a retrospective chart review of 346 patients with meningomyelocele and shunt-dependent hydrocephalus. Fifty-one patients had seizures. Seizure episodes were investigated to determine whether they were temporally associated with shunt dysfunction. Episodes of actual or presumed shunt dysfunction were analyzed as to presenting symptoms, ventriculogram, computed tomography scan, and shunt film results. These 51 patients had 129 admissions for possible shunt dysfunction. One hundred one admissions were due to increased intraventricular pressure; nine (9%) of these, had a seizure as one of the presenting symptoms. All of the nine episodes had other common presenting symptoms of shunt dysfunction, such as headache, vomiting, lethargy, or respiratory compromise. We conclude that seizures alone are an inadequate predictor of shunt dysfunction in children with meningomyelocele, but can be seen as one of the presenting symptoms.