Maria Punchak1,2, Edith Mbabazi Kabachelor3, Michael Ogwal3, Esther Nalule3, Joyce Nalwoga3, Peter Ssenyonga3, John Mugamba3, Abbas Rattani1,4, Michael C Dewan1,5, Abhaya V Kulkarni6, Steven J Schiff7, Benjamin Warf1,3,8. 1. Global Neurosurgery Initiative, Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts. 2. David Geffen School of Medicine, University of California, Los Angeles, California. 3. CURE Children's Hospital, Mbale, Uganda. 4. Meharry Medical College, School of Medicine, Nashville, Tennessee. 5. Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee. 6. Division of Neurosurgery, Hospital for Sick Children, Toronto, Canada. 7. Center for Neural Engineering, Department of Engineering Science and Mechanics, The Pennsylvania State University, University Park, Pennsylvania. 8. Department of Neurosurgery, Boston Children's Hospital, Boston, Massachusetts.
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). Mean time to seizure onset was 8.5 mo for ETV/CPC and 11.2 mo 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.
RCT Entities:
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%) patientsdied, 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). Mean time to seizure onset was 8.5 mo for ETV/CPC and 11.2 mo 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.
Authors: Ian C Coulter; Michael C Dewan; Jignesh Tailor; George M Ibrahim; Abhaya V Kulkarni Journal: Childs Nerv Syst Date: 2021-05-15 Impact factor: 1.475
Authors: A S Barkley; S Boop; J K Barber; A Lee; S R Browd; J G Ojemann; R G Ellenbogen; J S Hauptman Journal: Childs Nerv Syst Date: 2021-02-18 Impact factor: 1.475
Authors: Jacob R Lepard; Michael C Dewan; Stephanie H Chen; Olufemi B Bankole; John Mugamba; Peter Ssenyonga; Abhaya V Kulkarni; Benjamin C Warf Journal: BMJ Glob Health Date: 2020-02-23