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CURE International is a global nonprofit network of children’s hospitals providing surgical care in a compassionate, gospel-centered environment. Services are provided at no cost to families because of the generosity of donors and partners like you.

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Neurosurgery

The incidence of postoperative seizures following treatment of postinfectious hydrocephalus in Ugandan Infants: A post hoc comparison of endoscopic treatment vs shunt placement in a randomized controlled trial

Abstract:

Background: There are currently no published data directly comparing postoperative seizure incidence following endoscopic third ventriculostomy (ETV),with/without choroid plexus cauterization (CPC), to that for ventriculoperitoneal shunt (VPS) placement. OBJECTIVE: To compare postoperative epilepsy incidence for ETV/CPC and VPS in Ugandan infants treated for postinfectious hydrocephalus (PIH).

Methods: We performed an exploratory post hoc analysis of a randomized trial comparing VPS and ETV/CPC in 100 infants (<6 mo old) presenting with PIH. Minimum follow-up was 2 yr. Variables associated with and the incidence of postoperative epilepsy were compared (intention-to-treat) using a bivariate analysis. Time to first seizure was compared using the Kaplan–Meier method, and the relative risk for the 2 treatments was determined using Mantel-Haenszel hazard ratios.

Results: Seizure incidence was not related to age (P = .075), weight (P = .768), sex (P=.151), head circumference(P=.281),time from illness to hydrocephalus onset (P=.973), or hydrocephalus onset to treatment (P = .074). Irritability (P = .027) and vision deficit (P = .04) were preoperative symptoms associated with postoperative seizures. Ten (10%) patients died, and 20 (20%) developed seizures over the follow-up period. Overall seizure incidence was 9.4 per 100 person-years (9.4 and 9.5 for ETV/CPC and VPS, respectively; P =.483), with no significant difference in seizure risk between groups (hazard ratio, 1.02; 95%CI:0.42,2.45; P=.966).Meantimetoseizureonsetwas8.5moforETV/CPCand11.2mo for VPS (P=.464).As-treated, per-protocol, and attributable-intervention analyses yielded similar results.

Conclusion: Postoperative seizure incidence following treatment of PIH was 20% within 2 yr, regardless of treatment modality.

Publication: Journal of Neurosurgery
Publication Year: 2019
Authors: Punchak, M. , Mbabazi Kabachelor, E. , Ogwal, M. , Nalule, E. , Nalwoga, J. , Ssenyonga, P. , Mugamba, J. , Rattani, A. , Dewan, M. C. , Kulkarni, A. V. , Schiff, S. J. , Warf, B.
Tags
Epilepsy
ETV/CPC
Global neurosurgery
Postinfectious hydrocephalus
Seizures
Uganda
Ventriculoperitoneal shunt
VPS