Risk Factors for Postshunt Seizures in Shunttreated Kenyan Children With Hydrocephalus

Abstract

Background: Hydrocephalus is one of the most common conditions managed by any neurosurgical service. Shunt-treated hydrocephalus is a condition that affects many children in Africa and Kenya and is associated with a high risk of developing post-shunt seizures, which can impair their developmental outcome and quality of life. Post-shunt seizures, as a complication of shunt- treated hydrocephalus, is a major obstacle in the management of hydrocephalus. However, there is a lack of reliable and comprehensive data on the epidemiology and aetiology of seizures in this population. Data and associated factors concerning shunt-treated hydrocephalus and seizures would be useful in improving neurosurgical services. The objective of this study is to determine the risk factors for postshunt seizures in shunt-treated Kenyan children with hydrocephalus Materials and methods: The study used a non-interventional, prospective, single-centre cohort design. The study collected data from shunt-treated children with hydrocephalus who were admitted to Kenyatta National Hospital (KNH) for the first time during the study period. The study collected data on their demographic, clinical, radiological, surgical, and seizure characteristics at baseline and at regular intervals during the follow-up period. The study used various data sources, such as medical records and questionnaires. The study employed descriptive as well as inferential statistics to examine the data and answer the research questions. The study used survival analysis to estimate the incidence together with risk elements for certain seizure characteristics in children with hydrocephalus treated using shunts. Results: The cohort comprised 72 participants, 56.9% were male and 43.1% were female. Household income levels were distributed as follows: 44.4% earned less than 24,000, 40.3%

earned between 24,000 and 120,000, and 13.9% earned more than 120,000. Most participants resided in Nairobi (25.0%). Clinically, 63.9% of the hydrocephalus cases were congenital, and 36.1% were acquired. The predominant pathoaetiologies were aqueduct stenosis (27.8%), spina bifida (16.7%), and tumors (16.7%). At the time of data collection, 22.2% had concurrent infections. Surgically, the majority (72.2%) underwent primary shunt insertion, while 11.1% had shunt revisions due to complications such as blockage (5.6%), migration (1.4%), or infection (1.4%). Seizure characteristics revealed that 87.5% of the participants experienced seizures. The duration of seizures was divided between those lasting seconds (54%) and those lasting minutes (46%). The frequency of seizures ranged from 2 to 5 episodes per 24 hours for 77.4% of participants. Generalized onset seizures were the most common type (52.5%). EEG findings were abnormal in 88.5% of participants, and 96.7% were on antiepileptic drugs (AEDs), with 89.8% receiving an adequate dosage. Associated epilepsy complications included delayed milestones (36.1%) and low concentration or learning difficulties (each at 4.2%). Imaging indicated that 47.2% had no brain anomalies, while 13.9% had severe hydrocephalus. AED use was significantly associated with a reduction in seizure frequency (p = 0.040). Additionally, the response to AEDs was significantly linked to seizure type, with children experiencing fully controlled seizures more likely to have focal onset seizures (p = 0.022). Conclusion: The study provides a detailed overview of the socio-demographic, clinical, and surgical characteristics of patients with shunt-treated hydrocephalus with seizures. It highlights that while most factors studied did not significantly influence seizure characteristics, the use of AEDs and their effectiveness in controlling seizures were important factors