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Epilepsy in Children With Congenital Heart Disease: Risk Factors and Characteristic Presentations
Takashi Shibata1, Maiko Kondo2, Yosuke Fukushima2
1Department of Child Neurology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences and Okayama University Hospital, Okayama, Japan.
Insights
Children with congenital heart disease (CHD) face higher epilepsy risks. Underlying disease and high-risk surgery scores increase this likelihood, with autonomic seizures often missed.
Area of Science:
- Pediatric Cardiology
- Neurology
- Clinical Research
Background:
- Children with congenital heart disease (CHD) have an elevated risk of epilepsy.
- Detailed characteristics of CHD-associated epilepsy remain unclear.
Purpose of the Study:
- Identify risk factors for epilepsy in pediatric CHD patients.
- Characterize epilepsy in children with CHD.
Main Methods:
- Retrospective cohort study of 1024 pediatric patients with CHD.
- Analysis of medical records from birth to age three years.
- Multivariate logistic regression to identify epilepsy risk factors.
Main Results:
- 4.0% (41/1024) of patients developed epilepsy.
- Underlying disease and high Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery scores (categories 2 and 5) were significant risk factors.
- Autonomic seizures with vomiting, often overlooked, were noted in 15 epilepsy patients.
Conclusions:
- Risk factors for epilepsy in children with CHD have been identified.
- Autonomic seizures with vomiting are a key symptom in CHD-associated epilepsy.
Background:
Children with a congenital heart disease (CHD) are at a higher risk of developing epilepsy than the general population, but detailed characteristics of CHD-associated epilepsy have not been clarified. The purposes of this study were to determine the risk factors for developing epilepsy associated with CHD and to elucidate the characteristics of such epilepsy.
Methods:
We performed a retrospective cohort study based on medical records of pediatric patients with CHD who were born between January 2006 and December 2016, underwent cardiac surgery at Okayama University Hospital, and were followed up until at least age three years. Multivariate logistic regression analysis was used to determine factors particularly associated with epilepsy occurrence. In patients who developed epilepsy, clinical data on seizure characteristics were further investigated.
Results:
We collected data from 1024 patients, and 41 (4.0%) developed epilepsy. The presence of underlying disease (odds ratio [OR]: 2.413; 95% confidence interval [CI]: 1.150 to 4.883) and the Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery score category 2 (OR: 4.373; 95% CI: 1.090 to 29.150) and category 5 (OR: 10.385; 95% CI: 1.717 to 89.016) were significantly related to epilepsy occurrence. Of the 41 patients with epilepsy, 15 (including nine with hypoplastic left heart syndrome) had focal impaired awareness seizures specified as autonomic seizures with vomiting, which tends to escape detection.
Conclusions:
We clarified the risk factors for developing epilepsy in children with CHD. We also found that autonomic seizure with vomiting is an important symptom in these children.
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