Clinical and Surgical Factors Associated With Increased Epilepsy Risk in Children With Hydrocephalus
Hannah M Tully1, Walter A Kukull2, Beth A Mueller3
1Division of Pediatric Neurology, University of Washington, Seattle, Washington.
Insights
Epilepsy is common in children with hydrocephalus. Other hydrocephalus subtypes significantly increase epilepsy risk compared to spina bifida-associated cases, and surgical infections double this risk.
Area of Science:
- Pediatric Neurology
- Neurosurgery
- Developmental Pediatrics
Background:
- Children with hydrocephalus face increased epilepsy risk from the condition and its surgical treatment.
- The specific contributions of hydrocephalus subtypes and surgical factors to epilepsy risk are not well understood.
Purpose of the Study:
- To characterize epilepsy in children with infancy-onset hydrocephalus.
- To investigate epilepsy risks associated with hydrocephalus subtypes and surgical treatment factors.
Main Methods:
- Longitudinal cohort study of 379 children with infancy-onset hydrocephalus (2002-2012).
- Follow-up until April 2015 to assess epilepsy outcomes.
- Poisson regression analysis to determine risk ratios and confidence intervals.
Main Results:
- 23% of children (86/379) developed epilepsy, with a mean onset age of 2.7 years.
- Hydrocephalus subtypes other than spina bifida-associated hydrocephalus showed a fourfold increased epilepsy risk.
- Surgical infection doubled epilepsy risk (RR=2.0), and intracranial surgical failure increased risk (RR=1.7).
Conclusions:
- Epilepsy is a frequent complication in pediatric hydrocephalus.
- Specific hydrocephalus subtypes and surgical complications like infection significantly elevate epilepsy risk.
- Early identification and management of surgical risks may help mitigate epilepsy development.
Background:
Children with hydrocephalus are at risk for epilepsy both due to their underlying condition and as a consequence of surgical treatment; however, the relative contributions of these factors remain unknown.
Objective:
The authors sought to characterize epilepsy among children with infancy-onset hydrocephalus and to examine the risks of epilepsy associated with hydrocephalus subtype and with factors related to surgical treatment.
Methods:
We conducted a longitudinal cohort study of all children with infancy-onset hydrocephalus treated at a major regional children's hospital during 2002 to 2012, with follow-up to ascertain risk factors and epilepsy outcome through April 2015. Poisson regression was used to calculate adjusted risk ratios and 95% confidence intervals for associations.
Results:
Among 379 children with hydrocephalus, 86 (23%) developed epilepsy (mean onset age = 2.7 years), almost one fifth of whom had a history of infantile spasms. Relative to spina bifida-associated hydrocephalus, children with other major hydrocephalus subtypes had fourfold higher risks of developing epilepsy. Among children who underwent surgery, surgical infection doubled the risk of epilepsy (risk ratio = 2.0, 95% confidence interval = 1.4 to 3.0). Epilepsy was associated with surgical failure for intracranial reasons but not extracranial reasons (risk ratio = 1.7, 95% confidence interval = 1.1 to 2.7; risk ratio = 1.1, 95% confidence interval = 0.7 to 1.9, respectively).
Conclusions:
Epilepsy is common among children with hydrocephalus. Compared with children with spina bifida-associated hydrocephalus, children with other major hydrocephalus subtypes have a markedly increased risk of epilepsy. Surgical infection doubles the risk of epilepsy.
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