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Risk and risk factors for epilepsy in shunt-treated children with hydrocephalus
S Schubert-Bast1, L Berghaus2, N Filmann3
1Department of Neuropediatrics, Goethe-University, Frankfurt am Main, Germany; Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe-University, Frankfurt am Main, Germany.
Insights
Children with hydrocephalus (HC) face a high risk of developing epilepsy, primarily linked to the cause of HC, especially brain hemorrhage. Shunt revisions and brain damage increase epilepsy risk, while age at shunt implantation does not significantly impact it.
Area of Science:
- Pediatric Neurology
- Neurosurgery
- Developmental Pediatrics
Background:
- Epilepsy is a significant comorbidity in children with hydrocephalus (HC), impacting developmental outcomes.
- Identifying individual epilepsy risk factors in children with HC is challenging due to variable influencing factors.
Purpose of the Study:
- To analyze risk factors for developing epilepsy in children with shunted hydrocephalus.
- To investigate the influence of shunt therapy, revisions, and complications on epilepsy development.
Main Methods:
- Retrospective, single-center analysis of 361 patients diagnosed with hydrocephalus.
- Consideration of age at diagnosis, shunt treatment details, epilepsy development and course, and HC etiology.
- Investigation into the impact of shunt therapy, revisions, and complications on epilepsy incidence.
Main Results:
- 39.6% of patients with HC developed epilepsy, with a median onset at 300 days.
- Hydrocephalus etiology is the most significant factor (HR 5.9), with brain hemorrhage posing the highest risk (HR 7.9).
- Epilepsy risk increases with shunt revisions (HR 2.0 after ≥3 revisions); age at shunt implantation and sex showed no significant influence.
Conclusions:
- Children with HC are at high risk for epilepsy, mainly correlated with HC etiology.
- Brain hemorrhage is a primary risk factor; shunt revisions and structural brain damage are independent risk factors.
- Epilepsy onset typically occurs within 500 days of HC diagnosis; age at shunt implantation is not a significant factor.
Object:
Epilepsy is a major comorbidity in children with hydrocephalus (HC) and has a serious impact on their developmental outcomes. There are variable influencing factors, thus the individual risk for developing epilepsy remains unclear. Our aim was to analyse risk factors for developing epilepsy in children with shunted HC.
Methods:
A retrospective, single-centre analysis of 361 patients with the diagnosis of HC was performed. Age at HC diagnosis, shunt treatment, development of epilepsy, epilepsy course, and the aetiology of HC were considered. The influence of shunt therapy, including its revisions and complications, on the development of epilepsy was investigated.
Results:
One-hundred forty-three patients with HC (n = 361) had a diagnosis of epilepsy (39.6%). The median age at the first manifestation of epilepsy was 300 days (range:1-6791; Q1:30, Q3: 1493). The probability of developing epilepsy after HC decreases with increasing age. The most significant influence on the development of epilepsy is that of the HC itself and its underlying aetiology (HR 5.9; 95%-CI [3-10.5]; p < 0.001). Among those, brain haemorrhage is associated with the highest risk for epilepsy (HR 7.9; 95%-CI [4.2-14.7]; p < 0.01), while shunt insertion has a lower influence (HR 1.5; 95%-CI [0.99; 2.38]; p = 0.06). The probability of epilepsy increases stepwise per shunt revision (HR 2.0; p = 0.03 after 3 or more revisions). Five hundred days after the development of HC, 20% of the children had a diagnosis of epilepsy. Shunt implantation at a younger age has no significant influence on the development of epilepsy nor does sex.
Conclusion:
Children with HC are at high risk for developing epilepsy. The development of epilepsy is correlated mainly with HC's underlying aetiology. The highest risk factor for the development of epilepsy seems to be brain haemorrhage. The age at shunt implantation appears to be unrelated to the development of epilepsy, while structural brain damage at a young age, shunt revisions and complications are independent risk factors. The onset of epilepsy is most likely to take place within the first 500 days after the diagnosis of HC.
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