Abstracts

RATIONALE: We recently reported that SE occurs frequently (7.4%) in a prospectively-followed pediatric neurosurgical population. The overall mortality was elevated at 9.1% compared with the published rate of 6%. To determine if the frequent occurrence of SE and the increased mortality were related to ventricular shunting, epilepsy, or the patient[ssquote]s underlying cerebral pathology, the shunted group (252) and those without ventricular shunts (229) were separately analyzed.
METHODS: A prospectively-collected 10-year database of children ([lt] 18 years) requiring neurosurgery was cross-referenced with our established prospective SE database. Patient charts including discharge summaries, operative notes, consultation reports, and clinic notes were additionally reviewed.
RESULTS: 24.2% of children with shunts had epilepsy versus 21.8% of those without shunts. In the shunted group 23 patients had 34 SE events including 16 epileptic patients and 7 patients with SE as their first seizure. 5 of these 7 developed epilepsy. 9 children without shunts had 10 SE events, 3 of whom experienced SE as their first seizure. 4 of these 9 were epileptic, while 2 of the 3 new onset SE patients went on to develop epilepsy. Two large pediatric SE cohorts described the most common presentation as 2[degree] to acute symptomatic issues in 27.7%. Our shunted population presented this way in 38.2% compared with 60% of the non-shunted. None of the shunted children died within 30 days of their SE event compared with 30% of the general pediatric neurosurgery population. Additionally, in our hydrocephalus cohort, 9 patients had SE as the presenting symptom of shunt malfunction, and 7 of these same patients had other more brief seizures heralding an acute shunt malfunction. The other 2 patients had isolated SE and following shunt revision remained free of seizures.
CONCLUSIONS: These data suggest that children with shunted hydrocephalus have a uniquely high incidence of SE, but otherwise behave similarly to children with epilepsy regarding seizure incidence and SE mortality. The general neurosurgical group has a markedly elevated mortality rate and more frequently present with acute symptoms. These data support the contention that underlying structural brain pathology plays a more important role in SE in the non-shunted group than in hydrocephalic children, and that although shunted children need to be more closely monitored for hardware malfunction when breakthrough seizures or SE occurs, their outcome is usually very good.
Support: the NIH (P01NS23560) and a National Epifellows Foundation Grant.