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West syndrome following deep hypothermic infant cardiac surgery
A J du Plessis1, U Kramer, R A Jonas
1Department of Neurology, Children's Hospital, Boston, Massachusetts 02115.
Insights
Early seizures after pediatric cardiac surgery may lead to West syndrome, a severe neurological disorder. This previously unreported complication highlights the need for closer monitoring of these infants.
Area of Science:
- Pediatric Neurology
- Pediatric Cardiology
- Developmental Neuroscience
Background:
- Postoperative seizures following pediatric cardiac surgery are common but typically considered benign.
- The long-term prognostic significance of these seizures has been poorly understood.
Observation:
- Four infants developed West syndrome, characterized by infantile spasms, hypsarrhythmia, and developmental delay, after early postoperative seizures post-cardiac surgery.
- These infants represented 6% of all infantile spasms evaluated over a 5-year period at Boston Children's Hospital.
Findings:
- The postoperative seizures in these infants were unusually resistant to antiepileptic drug treatment.
- No specific intraoperative or perioperative factors differentiated these infants from those with seemingly benign "postpump seizures."
Implications:
- This study identifies a novel, serious complication of pediatric cardiac surgery: the development of West syndrome.
- It suggests that early postoperative seizures in infants undergoing cardiac surgery may warrant closer neurological monitoring and evaluation for developmental impact.
Abstract:
Postoperative seizures are among the more common complications of cardiac surgery in children. These seizures have traditionally been considered benign, transient phenomena with little, if any, prognostic significance. We report 4 infants with early postoperative seizures following cardiac surgery who later developed the previously unreported complication of West syndrome, with infantile spasms, hypsarrhythmia, and developmental delay. This group constitutes 6% of 67 infant spasms evaluated over a 5-year period at Boston Children's Hospital. The postoperative seizures in these 4 patients were more difficult than usual to control with antiepileptic therapy; otherwise no intra- or perioperative features distinguished these infants who later developed West syndrome from infants with apparently benign "postpump seizures."