Department of Neuropediatrics, Goethe-University, Frankfurt am Main, Germany; Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe-University, Frankfurt am Main, Germany.
Department of Neuropediatrics, Goethe-University, Frankfurt am Main, Germany.
Eur J Paediatr Neurol. 2019 Nov;23(6):819-826. doi: 10.1016/j.ejpn.2019.09.004. Epub 2019 Sep 10.
Epilepsy is a major comorbidity in children with hydrocephalus (HC) and has a serious impact on their developmental outcomes. There are variable influencing factors, thus the individual risk for developing epilepsy remains unclear. Our aim was to analyse risk factors for developing epilepsy in children with shunted HC.
A retrospective, single-centre analysis of 361 patients with the diagnosis of HC was performed. Age at HC diagnosis, shunt treatment, development of epilepsy, epilepsy course, and the aetiology of HC were considered. The influence of shunt therapy, including its revisions and complications, on the development of epilepsy was investigated.
One-hundred forty-three patients with HC (n = 361) had a diagnosis of epilepsy (39.6%). The median age at the first manifestation of epilepsy was 300 days (range:1-6791; Q1:30, Q3: 1493). The probability of developing epilepsy after HC decreases with increasing age. The most significant influence on the development of epilepsy is that of the HC itself and its underlying aetiology (HR 5.9; 95%-CI [3-10.5]; p < 0.001). Among those, brain haemorrhage is associated with the highest risk for epilepsy (HR 7.9; 95%-CI [4.2-14.7]; p < 0.01), while shunt insertion has a lower influence (HR 1.5; 95%-CI [0.99; 2.38]; p = 0.06). The probability of epilepsy increases stepwise per shunt revision (HR 2.0; p = 0.03 after 3 or more revisions). Five hundred days after the development of HC, 20% of the children had a diagnosis of epilepsy. Shunt implantation at a younger age has no significant influence on the development of epilepsy nor does sex.
Children with HC are at high risk for developing epilepsy. The development of epilepsy is correlated mainly with HC's underlying aetiology. The highest risk factor for the development of epilepsy seems to be brain haemorrhage. The age at shunt implantation appears to be unrelated to the development of epilepsy, while structural brain damage at a young age, shunt revisions and complications are independent risk factors. The onset of epilepsy is most likely to take place within the first 500 days after the diagnosis of HC.
癫痫是脑积水（HC）患儿的主要合并症，对其发育结局有严重影响。影响因素各不相同，因此个体发生癫痫的风险尚不清楚。本研究旨在分析分流治疗后脑积水患儿发生癫痫的危险因素。
对 361 例 HC 患儿的诊断进行回顾性单中心分析。考虑 HC 诊断时的年龄、分流治疗、癫痫的发生、癫痫病程以及 HC 的病因。研究了分流治疗，包括其修订和并发症，对癫痫发生的影响。
143 例 HC 患儿（n=361）诊断为癫痫（39.6%）。癫痫首次发作的中位年龄为 300 天（范围：1-6791；Q1：30，Q3：1493）。随着年龄的增长，HC 后发生癫痫的可能性降低。对癫痫发生影响最大的是 HC 本身及其潜在病因（HR 5.9；95%CI [3-10.5]；p<0.001）。其中，脑出血与癫痫风险最高相关（HR 7.9；95%CI [4.2-14.7]；p<0.01），而分流插入的影响较低（HR 1.5；95%CI [0.99；2.38]；p=0.06）。每进行一次分流修订，癫痫的概率就会逐步增加（第 3 次或更多次修订后 HR 2.0；p=0.03）。HC 发生后 500 天，有 20%的患儿诊断为癫痫。HC 发病时年龄较小、性别均对癫痫的发生无显著影响。
HC 患儿发生癫痫的风险较高。癫痫的发生主要与 HC 的潜在病因相关。脑出血似乎是癫痫发生的最高危险因素。分流植入的年龄似乎与癫痫的发生无关，而年幼时的结构性脑损伤、分流修订和并发症是独立的危险因素。癫痫的发作最有可能发生在 HC 诊断后的前 500 天内。
