Epilepsy in Childhood Shunted Hydrocephalus

  • Marie BourgeoisEmail author
  • Christian Sainte-Rose
  • Giuseppe Cinalli
  • Wirginia Maixner
  • Jean Aicardi
Living reference work entry


Object. The incidence of epilepsy among children with hydrocephalus is well recognized. Its relation to shunts and with the transient episodes of raised intracranial pressure related with shunt obstruction can be a complicating factor of the management of shunt malfunction. In this chapter the authors review a series of 802 children with hydrocephalus of different etiologies, treated by ventriculoperitoneal shunt placement between 1980 and 1990, with a mean follow-up period of 8 years. Patients with tumoral hydrocephalus were excluded. Data extracted from medical records were retrospectively analyzed. Thirty-two percent of the children had epilepsy. In most of the cases, the onset was contemporary with the diagnosis of hydrocephalus. Severe uncontrolled epilepsy was present in most of the cases. The incidence of epilepsy was mainly related with the original cause of the hydrocephalus. The presence of radiological abnormalities was a significant predictor of epilepsy. Similarly, shunt complications with related periods of raised intracranial pressure predisposed to epilepsy. The presence of a shunt by itself was found to be able to promote an epileptogenic focus. Epilepsy is an important predictor of poor intellectual outcome in hydrocephalic children with shunts.


Epilepsy Seizures Children Hydrocephalus Ventriculoperitoneal shunt malfunction Slit ventricle syndrome CSF shunt obstruction 


  1. Albright A, Haines S, Taylor F (1988) Function of parietal and frontal shunts in childhood hydrocephalus. J Neurosurg 69:883–886CrossRefPubMedGoogle Scholar
  2. Bartoshesky L, Haller J, Scott R et al (1985) Seizures in children with meningomyelocele. Am J Dis Child 139(4):400–402PubMedGoogle Scholar
  3. Bierbrauer K, Storrs B, McLone DG et al. (1990–1991) A prospective, randomized study of shunt function and infections as a function of shunt placement. Pediatr Neurosurg 16:287–291Google Scholar
  4. Blaauw G (1978) Hydrocephalus and epilepsy. Z Kinderchir 25:341–345Google Scholar
  5. Chadduck W, Adametz J (1988) Incidence of seizures in patients with myelomeningocele: a multifactorial analysis. Surg Neurol 30(4):281–285CrossRefPubMedGoogle Scholar
  6. Copeland G, Foy P, Shaw M (1982) The incidence of epilepsy after ventricular shunting operations. Surg Neurol 17(4):279–281CrossRefPubMedGoogle Scholar
  7. Dan N, Wade M (1986) The incidence of epilepsy after ventricular shunting procedures. J Neurosurg 65(1):19–21CrossRefPubMedGoogle Scholar
  8. Dennis M, Fitz C, Netley C et al (1981) The intelligence of hydrocephalic children. Arch Neurol 38(10):607–615CrossRefPubMedGoogle Scholar
  9. Di Rocco C, Iannelli A, Pallini R et al (1986) Epilepsy and its correlation with cerebral ventricular shunting procedures in infantile hydrocephalus. Ann Rev Hydrocephalus 4:74–75Google Scholar
  10. Faillace W, Canady A (1990) Cerebrospinal fluid shunt malfunction signaled by new or recurrent seizures. Childs Nerv Syst 6(1):37–40CrossRefPubMedGoogle Scholar
  11. Faulhauer K, Schmitz P (1978) Overdrainage phenomena in shunt treated hydrocephalus. Acta Neurochir (Wein) 45:89–1001CrossRefGoogle Scholar
  12. Fernell E, Hagberg B, Hagberg G et al (1988) Epidemiology of infantile hydrocephalus in Sweden: a clinical follow-up study in children born at term. Neuropediatrics 19(3):135–142CrossRefPubMedGoogle Scholar
  13. Finney H, Arlant P (1977) Focal seizure disorder secondary to multiple shunt revisions. A case report. Childs Brain 3(1):62–64PubMedGoogle Scholar
  14. Graebner R, Celesia G (1973) EEG findings in hydrocephalus and their relation to shunting procedures. Electroencephalogr Clin Neurophysiol 35(5):517–521CrossRefPubMedGoogle Scholar
  15. Hack C, Enrile B, Donat J et al (1990) Seizures in relation to shunt dysfunction in children with meningomyelocele [see comments]. J Pediatr 116(1):57–60CrossRefPubMedGoogle Scholar
  16. Hosking G (1974) Fits in hydrocephalic children. Arch Dis Child 49:633–635CrossRefPubMedPubMedCentralGoogle Scholar
  17. Ines DF, Markand ON (1977) Epileptic seizures and abnormal electroencephalographic findings in hydrocephalus and their relation to the shunting procedures. Electroencephalogr Clin Neurophysiol 42(6):761–768CrossRefPubMedGoogle Scholar
  18. Johnson D, Conry J, O’Donnell R (1996) Epileptic seizure as a sign of cerebrospinal fluid shunt malfunction. Pediatr Neurosurg 24(5):223–227; discussion 227–8CrossRefPubMedGoogle Scholar
  19. Keene D, Ventureyra E (1999) Hydrocephalus and epileptic seizures. Childs Nerv Syst 15:158–162CrossRefPubMedGoogle Scholar
  20. Klepper J, Büsse M, Straburg H (1998) Epilepsy in shunt-treated hydrocephalus. Dev Med Child Neurol 40:731–736CrossRefPubMedGoogle Scholar
  21. Laws EJ, Niedermeyer E (1970) EEG findings in hydrocephalic patients with shunt procedures. Electroencephalogr Clin Neurophysiol 29(3):325PubMedGoogle Scholar
  22. Leggate J, Baxter P, Minns R et al (1988) Role of a separate subcutaneous cerebro-spinal fluid reservoir in the management of hydrocephalus. Br J Neurosurg 2(3):327–337CrossRefPubMedGoogle Scholar
  23. Liguori G, Abate M, Buono S et al (1986) EEG findings in shunted hydrocephalic patients with epileptic seizures. Ital J Neurol Sci 7(2):243–247CrossRefPubMedGoogle Scholar
  24. Litofsky N, Raffel C, McComb J (1992) Management of symptomatic chronic extra-axial fluid collections in pediatric patients [see comments]. Neurosurgery 31(3):445–450CrossRefPubMedGoogle Scholar
  25. Lorber J, Sillanpaa M, Greenwood N (1978) Convulsions in children with hydrocephalus. Z Kinderchir Grenzgeb 49:346–351Google Scholar
  26. Majewska Z, Szelozynska K (1976) Epileptic fits in children with hydrocephalus. Acta Univ Carol Med Monogr 75:92–93Google Scholar
  27. Marossero F, Massarotti M (1970) Migliore A: [EEG abnormalities in infantile hydrocephalic subjects after ventriculo-atrial shunts]. [Italian]. Riv Neurol 40(4):239–241PubMedGoogle Scholar
  28. Noetzel M, Blake J (1991) Prognosis for seizure control and remission in children with myelomeningocele. Dev Med Child Neurol 33(9):803–810CrossRefPubMedGoogle Scholar
  29. Noetzel M, Blake J (1992) Seizures in children with congenital hydrocephalus: long-term outcome. Neurology 42(7):1277–1281CrossRefPubMedGoogle Scholar
  30. Pampiglione G, Laurence K (1962) Electroencephalographic and clinical pathological observation in hydrocephalic children. Arch Dis Childh 37:491–499CrossRefPubMedGoogle Scholar
  31. Piatt JJ, Carlson C (1996) Hydrocephalus and epilepsy: an actuarial analysis. Neurosurgery 39(4):722–727.; ; discussion 727–8CrossRefPubMedGoogle Scholar
  32. Prigatano G, Zeiner H, Pollay M et al (1983) Neuropsychological functioning in children with shunted uncomplicated hydrocephalus. Childs Brain 10:112–120PubMedGoogle Scholar
  33. Ralph K, Moylan P, Canady A et al (2000) The effects of multiple shunt revisions on neuropsychological functioning and memory. Neurol Res 22:131–136CrossRefPubMedGoogle Scholar
  34. Saukkonen A (1988) Electroencephalographic findings in hydrocephalic children prior to initial shunting. Childs Nerv Syst 4(6):339–343CrossRefPubMedGoogle Scholar
  35. Saukkonen A, Serlo W, von WL (1988) Electroencephalographic findings and epilepsy in the slit ventricle syndrome of shunt-treated hydrocephalic children. Childs Nerv Syst 4(6):344–347CrossRefPubMedGoogle Scholar
  36. Saukkonen A, Serlo W, von Wendt L (1990) Epilepsy in hydrocephalic children. Acta Paediatr Scand 79(2):212–218CrossRefPubMedGoogle Scholar
  37. Scarff J (1963) Treatment of hydrocephalus: an historical and critical review of method and results. J Neurol Neurosurg Psychiatry 26:1–26CrossRefPubMedPubMedCentralGoogle Scholar
  38. Sekhar L, Moossy J, Guthkelch A (1982) Malfunctioning ventriculoperitoneal shunts. Clinical and pathological features. J Neurosurg 56(3):411–416CrossRefPubMedGoogle Scholar
  39. Stellman G, Bannister C, Hillier V (1986) The incidence of seizure disorder in children with acquired and congenital hydrocephalus. Z Kinderchir 41(Suppl 1):38–41PubMedGoogle Scholar
  40. Sulaiman A, Ismail H (1998) Pattern of electroencephalographic abnormalities in children with hydrocephalus. Childs Nerv Syst 14:124–126CrossRefGoogle Scholar
  41. Talwar D, Baldwin M, Horbatt C (1995) Epilepsy in children with meningomyelocele. Pediatr Neurol 13(1):29–32CrossRefPubMedGoogle Scholar
  42. Varfis G, Berney J, Beaumanoir A (1977) Electro-clinical follow-up of shunted hydrocephalic children. Childs Brain 3(3):129–139PubMedGoogle Scholar
  43. Venes J, Dauser R (1987) Epilepsy following ventricular shunt placement [letter]. J Neurosurg 66(1):154–155PubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Marie Bourgeois
    • 1
    Email author
  • Christian Sainte-Rose
    • 1
  • Giuseppe Cinalli
    • 2
  • Wirginia Maixner
    • 3
  • Jean Aicardi
    • 1
  1. 1.Department of Pediatric NeurosurgeryNecker Enfants-MaladesParisFrance
  2. 2.Department of Pediatric NeurosurgerySantobono-Pausilipon Children’s HospitalNaplesItaly
  3. 3.Department of Pediatric NeurosurgeryRoyal Children’s HospitalMelbourneAustralia

Personalised recommendations