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Epilepsy in children with meningomyelocele
D Talwar1, M A Baldwin, C I Horbatt
1Department of Pediatrics, University of Arizona Health Sciences Center, Tucson 85724, USA.
Insights
Epilepsy affects about 17% of children with meningomyelocele (spina bifida). Most cases are linked to other central nervous system (CNS) issues, not just the spinal defect itself.
Area of Science:
- Pediatric Neurology
- Developmental Neuroscience
Background:
- Meningomyelocele is a complex congenital condition requiring lifelong multidisciplinary care.
- Hydrocephalus and shunt dependence are common complications in children with meningomyelocele.
- Seizures represent a significant comorbidity impacting neurological outcomes.
Purpose of the Study:
- To determine the incidence and characteristics of seizures in children with meningomyelocele.
- To investigate the association between epilepsy and other central nervous system (CNS) pathologies in this population.
- To evaluate the management and control of seizures in affected children.
Main Methods:
- Retrospective review of medical records for 81 children with meningomyelocele followed at a specialized clinic.
- Analysis of seizure occurrence, epilepsy diagnosis, antiepileptic drug use, and EEG findings.
- Correlation of seizure data with the presence of additional CNS abnormalities.
Main Results:
- Epilepsy was diagnosed in 17.3% of children with meningomyelocele.
- All children experiencing seizures had hydrocephalus requiring shunting.
- Most children with epilepsy (85.7%) exhibited additional CNS pathologies, including encephalomalacia, cerebral malformations, and calcifications.
Conclusions:
- Epilepsy is a notable complication in pediatric meningomyelocele, occurring in approximately 17% of cases.
- The presence of other central nervous system (CNS) pathologies is strongly associated with the development of seizures in this cohort.
- Further investigation into the specific CNS factors contributing to epilepsy in meningomyelocele is warranted.
Abstract:
The medical records of 89 children followed at a multidisciplinary Meningomyelocele Clinic at the Children's Clinics for Rehabilitative Services were reviewed. Almost all children in southern Arizona with meningomyelocele are followed at this clinic. Eight children (foreign nationals) were excluded because they were not eligible for neurosurgery/neurology services at the clinic. The remaining 81 children have been followed at the clinic from 0.25 to 21 years. Seventeen children (21%; age: 1.3-17 years, mean: 9.1 +/- 4.4 years; follow-up: 1.3-16 years) manifested seizures at some time during their course. All children with seizures had shunted hydrocephalus. Neonatal seizures occurred in 2 children currently not receiving medication. An additional 3 children had an acute symptomatic seizure associated with an intraventricular hemorrhage during ventriculoperitoneal shunt revision, 2 of whom later developed epilepsy. Fourteen children (17.3%) had epilepsy; 12 were taking antiepileptic drugs. Seizures were controlled on medication in 5 children. EEG abnormalities were present in 12 children (focal slowing 4, focal spikes 8, diffuse slowing 3, generalized or bilaterally synchronous spike-wave 4). Most of these children (12/14) had evidence of additional central nervous system (CNS) pathology (i.e., areas of encephalomalacia or past stroke 7, cerebral malformations 2, CNS calcifications 1, and frequent apneic spells/cardiac arrest 2). We conclude that epilepsy occurs in approximately 17% of children with meningomyelocele, and most have other CNS pathology to account for their seizures.