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Electro-clinical follow-up of shunted hydrocephalic children
Insights
Ventriculoatrial shunts in children with hydrocephalus can lead to epilepsy. An epileptogenic focus developed in 19 of 29 children, resulting in seizures in 17, highlighting a significant risk.
Area of Science:
- Pediatric Neurology
- Neurosurgery
- Epileptology
Background:
- Hydrocephalus is a condition requiring surgical intervention.
- Ventriculoatrial shunts are used to treat hydrocephalus.
- Potential complications of shunts include neurological deficits.
Purpose of the Study:
- To investigate the incidence of epileptogenic focus development after ventriculoatrial shunt insertion.
- To determine the rate of epileptic seizures in children treated with Holter valves.
- To explore factors influencing the development of seizures post-surgery.
Main Methods:
- Survey of 29 hydrocephalic children treated with ventriculoatrial (Holter) shunts.
- EEG monitoring before operation and annually for 4 years.
- Analysis of seizure incidence and correlation with clinical factors.
Main Results:
- An epileptogenic focus developed around the ventricular catheter in 19 out of 29 children.
- Epileptic seizures occurred in 17 children, with an incidence of 0.59 (95% CI: 0.39-0.76).
- Irritative EEG abnormalities typically appeared in the second year post-operation; seizure onset varied.
Conclusions:
- Ventriculoatrial shunting is associated with a significant risk of developing an epileptogenic focus and seizures.
- Age at operation, hydrocephalus type, and associated cerebral lesions may influence seizure development.
- Long-term EEG monitoring is crucial for identifying shunt-related neurological complications.
Abstract:
In a survey of 29 hydrocephalic children treated by ventriculoatrial shunt (Holter valve) with a follow-up of 4 years, EEG records before the operation and at least once a year thereafter, the authors can support the view that an epileptogenic focus has developed around the place of insertion of the ventricular catheter in 19 cases, leading to epileptic seizures in 17 up to now. Thus the incidence of convulsions in this particular group of patients is 0.59 (17/29), the limits of confidence 95% being 0.39-0.76. The irritative abnormalities occur usually during the second year after the operation and the delay for the onset of clinical seizures is variable. The age at operation seems to influence the occurrence of the epileptogenic scar. The type of hydrocephalus and especially the presence of an associated cerebral focal lesion can be of importance in the development of clinical seizures.