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Published on: July 18, 2014
Epilepsy and seizures in children with congenital heart disease: A prospective study
Beatrice Desnous1, Marien Lenoir2, Amélie Doussau3
1Clinique d'Investigation Neuro-Cardiaque (CINC), CHU Sainte-Justine, Montreal, Canada; Division of Neurology, Department of Neuroscience, Sainte-Justine University Hospital Center (SJUHC) and the University of Montreal, Montreal, Canada; SJUHC Research Centre, University of Montreal, Montreal, Canada.
Insights
Children with complex congenital heart disease (CHD) have a high risk of perioperative seizures and epilepsy. Surgical complexity, delayed sternal closure, and ECMO use were identified as key risk factors in this vulnerable population.
Area of Science:
- Pediatric Cardiology
- Pediatric Neurology
- Neurosurgery
Background:
- Complex congenital heart disease (CHD) is associated with a high incidence of seizures and epilepsy.
- Increasing survival rates in CHD patients necessitate understanding seizure and epilepsy impacts on long-term outcomes.
Purpose of the Study:
- To investigate the incidence and risk factors of perioperative clinical seizures (CS) and epilepsy.
- To characterize the underlying brain injury patterns in children with complex CHD undergoing cardiac surgery.
Main Methods:
- Prospective cohort study of 128 children with complex CHD followed for at least two years.
- Data collection included perinatal, surgical, critical care, and clinical follow-up information.
- Logistic regression analysis was used to identify risk factors for CS and epilepsy.
Main Results:
- The incidence of perioperative CS was 7.8%, with 3.1% developing epilepsy.
- Higher surgical complexity, delayed sternal closure, ECMO use, and longer hospital/ICU stays were associated with CS.
- ECMO use and hospital stay also predicted epilepsy; 90% of CS patients had brain injuries, including stroke and hypoxic-ischemic injury (HII).
Conclusions:
- This study highlights a significant incidence of perioperative seizures and epilepsy in children with complex CHD.
- Surgical factors and brain injuries, particularly HII, are strongly linked to CS and subsequent epilepsy.
- Further research is needed to explore the neurodevelopmental and quality-of-life implications of epilepsy in this population.
Purpose:
Children with complex congenital heart disease (CHD) experience high incidence of perioperative seizures. Population-based studies also report high epilepsy co-morbidity in CHD. Given the increasing survival of patients with CHD and the interference of seizures and epilepsy with the long-term outcomes, characterizing them in this population is of high relevance. This study investigated the incidence and risk factors of perioperative clinical seizures (CS) and epilepsy in a prospective cohort of children with complex CHD who underwent cardiac surgery.
Methods:
We included 128 consecutive children with CHD, followed for at least two years at the neurocardiac clinic of Montreal's Sainte-Justine University Hospital Center. We collected perinatal, surgical, critical care and clinical follow-up information and performed logistic regression to reveal risk factors of CS and epilepsy.
Results:
Ten patients (7.8%) experienced perioperative CS. Four of them (40%) developed epilepsy. The incidence of epilepsy was therefore 3.1%. Higher surgical complexity scores, delayed sternal closure, extracorporeal membrane oxygenation (ECMO) use, longer intensive care and hospital stay were associated with CS. ECMO use and hospital stay were also associated with epilepsy. Nine (90%) patients with CS had brain injuries: five strokes, one white matter and three hypoxic-ischemic injury (HII). All patients with HII developed epilepsy, which became intractable in one of them.
Conclusion:
Our study reports high incidence, surgical risk factors and brain injury patterns underlying CS and epilepsy in CHD. Further studies are needed to investigate how epilepsy interferes with neurodevelopment and quality of life in CHD.
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