title: Clinical and Surgical Factors Associated With Increased Epilepsy Risk in Children With Hydrocephalus.
abstract: Children with hydrocephalus are at risk for epilepsy both due to their underlying condition and as a consequence of surgical treatment; however, the relative contributions of these factors remain unknown.
  
  
  
  The authors sought to characterize epilepsy among children with infancy-onset hydrocephalus and to examine the risks of epilepsy associated with hydrocephalus subtype and with factors related to surgical treatment.
  
  
  
  We conducted a longitudinal cohort study of all children with infancy-onset hydrocephalus treated at a major regional children's hospital during 2002 to 2012, with follow-up to ascertain risk factors and epilepsy outcome through April 2015. Poisson regression was used to calculate adjusted risk ratios and 95% confidence intervals for associations.
  
  
  
  Among 379 children with hydrocephalus, 86 (23%) developed epilepsy (mean onset age = 2.7 years), almost one fifth of whom had a history of infantile spasms. Relative to spina bifida-associated hydrocephalus, children with other major hydrocephalus subtypes had fourfold higher risks of developing epilepsy. Among children who underwent surgery, surgical infection doubled the risk of epilepsy (risk ratio = 2.0, 95% confidence interval = 1.4 to 3.0). Epilepsy was associated with surgical failure for intracranial reasons but not extracranial reasons (risk ratio = 1.7, 95% confidence interval = 1.1 to 2.7; risk ratio = 1.1, 95% confidence interval = 0.7 to 1.9, respectively).
  
  
  
  Epilepsy is common among children with hydrocephalus. Compared with children with spina bifida-associated hydrocephalus, children with other major hydrocephalus subtypes have a markedly increased risk of epilepsy. Surgical infection doubles the risk of epilepsy.
authors.affiliation: Division of Pediatric Neurology, University of Washington, Seattle, Washington. Electronic address: hmtully@uw.edu.
authors.forename: Hannah M
authors.initials: HM
authors.lastname: Tully
authors.affiliation: Department of Epidemiology, University of Washington, Seattle, Washington.
authors.forename: Walter A
authors.initials: WA
authors.lastname: Kukull
authors.affiliation: Department of Epidemiology, University of Washington, Seattle, Washington; Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington.
authors.forename: Beth A
authors.initials: BA
authors.lastname: Mueller
mesh_terms: D002648:Child; D002675:Child, Preschool; D004827:Epilepsy / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006849:Hydrocephalus / Q000150:complications / Q000453:epidemiology* / Q000503:physiopathology / Q000601:surgery; D008137:Longitudinal Studies; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors
keywords: aqueductal stenosis; epilepsy; hydrocephalus; infantile spasms; spina bifida