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Seizures as presentation of shunt malfunction: tertiary paediatric neurosurgery experience
Aimee Goel1, Vesta S Najmi1, Katie Herbert1
1Department of Neurosurgery, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, UK.
Insights
Seizures are a rare indicator of cerebrospinal fluid (CSF) shunt malfunction in pediatric patients. In a 14-year study, only 2.9% of shunted children presenting with seizures had confirmed shunt malfunction.
Area of Science:
- Pediatric Neurology
- Neurosurgery
- Medical Device Malfunction
Background:
- Patients with cerebrospinal fluid (CSF) shunts often present with seizures, leading to investigations for shunt malfunction.
- Limited evidence exists on the direct association between seizures and shunt malfunction.
- This study addresses the diagnostic utility of seizures in identifying shunt issues in pediatric populations.
Purpose of the Study:
- To determine the incidence of shunt malfunction in pediatric patients with seizures.
- To evaluate the effectiveness of seizures as a marker for shunt malfunction.
- To analyze the characteristics of seizures associated with shunt malfunction.
Main Methods:
- Retrospective analysis of shunted pediatric patients presenting with seizures from 2009-2023.
- Inclusion of patients undergoing shunt revision for seizure presentation.
- Exclusion of infected shunt cases; literature review conducted.
Main Results:
- 338 shunted patients presented with seizures; 10 (2.9%) had confirmed shunt malfunction requiring revision.
- Shunt malfunction represented 6.2% of all shunt revisions during the study period.
- Post-hemorrhagic hydrocephalus was the most common etiology; seizures occurred de novo or as a change in pattern in known epileptics.
Conclusions:
- Seizures are an uncommon manifestation of cerebrospinal fluid (CSF) shunt malfunction.
- Seizures can be a new onset or a change in frequency in patients with pre-existing epilepsy.
- The diagnostic yield of seizures for shunt malfunction is low, necessitating further investigation.
Aim:
Patients with a background of cerebrospinal fluid (CSF)-diverting shunts are frequently investigated for shunt malfunction when presenting with seizures. However, there is very limited evidence in the literature regarding the association of seizures and shunt malfunction. We sought to determine the incidence of shunt malfunction in our cohort of shunted paediatric patients presenting with seizures, and the utility of seizures as a marker of shunt malfunction.
Methods:
We retrospectively identified all shunted patients presenting with seizures, as well as all patients undergoing shunt revision following a presentation with seizures from our hospital database over a 14-year period from 2009 to 2023. Data gathered included demographics, de novo seizures or change in pattern of seizures, the aetiology of hydrocephalus and the segment of shunt requiring revision. Exclusion criteria included infected cases requiring shunt externalisation. A literature review of all papers discussing seizures as a presentation of shunt malfunction was also carried out.
Results:
Overall, over a 14-year period of study, 338 shunted patients presented with seizures and were referred as suspected shunt malfunction with 10 having confirmed shunt malfunction requiring revision (2.9%). This group represented 6.2% of 161 cases of shunt revision carried out during the 14-year period of study. Post-haemorrhagic hydrocephalus secondary to prematurity was the commonest aetiology of shunted hydrocephalus presenting with seizures. Out of 10 patients presenting with seizures with shunt malfunction, 4 presented with de novo seizures, while 6 presented with a change in seizure pattern or frequency in already known epileptic patients. Shunt revision surgeries included 5 distal catheter, 2 proximal catheter, 1 proximal catheter-valve, 1 valve only and 1 case of whole shunt change.
Conclusion:
Our data supports that seizures are rare manifestation of shunt malfunction and can present either de novo or with a change in seizure frequency in already-known epileptic patients.
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