Clinical and surgical factors associated with increased epilepsy risk in children with hydrocephalus

Abstract

BACKGROUND: Children with hydrocephalus are at risk for epilepsy due both to their underlying condition and as a consequence of surgical treatment. OBJECTIVE: We sought to characterize epilepsy among children with infancy-onset hydrocephalus and to examine the risks of epilepsy associated with hydrocephalus subtype and with factors related to surgical treatment of hydrocephalus. METHODS: Longitudinal cohort study of all children with infancy-onset hydrocephalus treated at a major regional children’s hospital during 2002 – 2012, with follow-up to ascertain surgical factors and epilepsy outcome through April, 2015. Poisson regression was used to calculate adjusted risk ratios (RRs) and 95% confidence intervals (CIs) for associations. RESULTS: Among 379 children with hydrocephalus, 86 (23%) developed epilepsy (mean onset age 2.7 years), almost one fifth of whom had a history of infantile spasms. The RR for epilepsy associated with having any surgery was 2.8 (95%CI: 1.3-5.8). Among children who had undergone surgery, shunt failure (RR: 1.9, 95%CI: 1.1, 3.3), and infection (RR 1.9, 95%CI: 1.2, 3.0) were independently associated with epilepsy. Relative to spina bifida-associated hydrocephalus, children with other major hydrocephalus subtypes had four- to five-fold increased risks of developing epilepsy. CONCLUSIONS: Epilepsy is common among children with hydrocephalus, and more common among those with shunt failure and infection. Relative to children with spina bifida-associated hydrocephalus, children with other major hydrocephalus subtypes have an increased risk of epilepsy.