1043-3155 Pediatr Neurol Briefs pedneurbriefs Pediatr Neurol Briefs Pediatric Neurology Briefs Pediatr Neurol Briefs 2166-6482 1043-3155 2166-3155 Pediatric Neurology Briefs Publishers Chicago, IL, USA PNB-2-73 10.15844/pedneurbriefs-2-10-1 Seizure Disorders Neurology Pediatrics Nervous System Diseases Child Development Brain Diseases Neurosurgery Child Infant Seizures and Ventricular Shunts http://orcid.org/0000-0002-0173-7931 Millichap J. Gordon MD 1 2 * Division of Neurology, Children's Memorial Hospital, Chicago, IL Departments of Pediatrics and Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL Correspondence: Dr. J. Gordon Millichap, E-mail: jgmillichap@northwestern.edu 11 1988 01 08 2016 2 10 73 74 Copyright: © 1988 The Author(s) 1988 This work is licensed under the Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Incidence of seizures in patients with myelomeningocele: a multifactorial analysis

The role of ventricular shunts as a cause of seizures in children with hydrocephalus was studied in 190 patients treated for myelomeningoele in the Dept of Neurosurgery, Arkansas Children's Hospital, Little Rock, AR.

 Ventricular Shunts Hydrocephalus Shunt Infection

The role of ventricular shunts as a cause of seizures in children with hydrocephalus was studied in 190 patients treated for myelomeningoele in the Dept of Neurosurgery, Arkansas Children's Hospital, Little Rock, AR. The period of follow-up was 1-26 yrs, with an average of 9 yrs. The frequency of seizures in 144 shunted compared to 46 nonshunted patients was 22% and 2%, respectively. If modification of the shunt was unnecessary, only 9% had seizures, whereas in those requiring modification the incidence was 22%. A shunt infection raised the risk of seizures to 47%. Seizure frequency was approximately the same in those with frontal or parietal location catheters, 20 and 26%, respectively. Of 7 patients with unorthodox locations of shunt placements, near the motor cortex, 4(57%) developed seizures. [1]

COMMENT. One in four infants with myelomeningocele who are shunted for hydrocephalus develop seizures. Cortical injury at the time of shunt placement is a likely factor in etiology, and a complicating bacterial infection, even low-grade in type, will lead to diffuse cerebral injury and will double the risk of seizures. Candida meningitis has been reported in patients with CSF shunts [2], and a single colony of yeast should not be considered a contaminant especially in infants with hydrocephalus, ventricular shunts and cranial nerve palsies [3]. McLone et al (Pediatrics 1982;70:338) have alluded to the effect of CNS infections on the intelligence of children with myelomeningocele, and the occurrence of seizures is a further complication of surgery. Delay in operative closure of the spina bifida may reduce the severity of hydrocephalus and lessen the need for shunting with its attendant risks (see Ped Neur Briefs 1988;2:52).

 Chadduck W Adametz J Incidence of seizures in patients with myelomeningocele: a multifactorial analysis Surg Neurol 1988 Oct 30 4 281 5 10.1016/0090-3019(88)90300-X 3175838 Sugarman B Massanari RM Candida meningitis in patients with CSF shunts Arch Neurol 1980 Mar 37 3 180 1 10.1001/archneur.1980.00500520078017 6766718 Coker SB Beltran RS Candida meningitis: clinical and radiographic diagnosis Pediatr Neurol 1988 Sep-Oct 4 5 317 9 10.1016/0887-8994(88)90074-4 3242537