Clinical Presentation of a Cohort of Pediatric Epilepsy Patients with Ventriculoperitoneal Shunt
Sugapradha Saravanan1, Parth Patel1, Madison Estrela1, Laura Fonseca2, Shoban Vachhrajani2, Grant Turek2, Mahesh Chikkannaiah2, Gogi Kumar2
1Wright State University Boonshoft School of Medicine, 2Dayton Children's Hospital
Objective:
To investigate clinical outcomes in patients with epilepsy and ventriculoperitoneal (VP) shunting and the clinical course of this group with respect to discontinuation of anti-seizure medications (ASMs).
Background:
The main causes of pediatric hydrocephalus include congenital malformations, central nervous system (CNS) hemorrhage, infection or tumor. The standard treatment for hydrocephalus is VP shunting. Previous studies indicate that patients with epilepsy and VP shunt have low rates of ASM discontinuation and seizure freedom.
Design/Methods:
A retrospective cohort study was conducted of 132 patients (ages 0-18) identified via the electronic medical record system – EPIC SlicerDicer. Inclusion criteria included patients who had undergone VP shunting and were diagnosed with epilepsy between January 2014 and October 2024. Data abstracted included patient demographics, VP shunting and revisions, seizure characterization, ASM history, and birth and medical history.
Results:
Most patients were male (59.1%), white (70.5%), and not-Hispanic/Latino (94.7%). The mean age at VP shunt insertion was 1.3 years (SD=2.9). After initial VP shunting, 75.2% of patients underwent at least one shunt revision and 20.0% had a history of shunt infection. The most common etiologies of hydrocephalus were hemorrhagic (34.6%) and CNS malformations (29.2%). The mean age at epilepsy diagnosis was 4.4 years (SD=5.2), with focal epilepsy as the most common type (63.8%). Most patients had tonic-clonic seizures (61.2%) and the predominant etiology of seizure was structural (76.8%). 78.6% of patients’ seizures were found to be well-controlled. 27.7% of patients successfully weaned off ASMs, while 22.7% had seizure recurrence after weaning. Intellectual disability (ID) was present in 74.6% of patients, with the majority having profound ID (43.8%).
Conclusions:
Majority of patients with epilepsy and VP shunt had well controlled seizures while over 20% of patients had seizure recurrence after discontinuing ASMs. These findings highlight the need for determining the variables that would predict seizure recurrence after weaning off ASMs.
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