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Refractory epilepsy associated with ventriculoperitoneal shunt over-drainage: case report

  • Michal Gafner
  • Tally Lerman-Sagie
  • Shlomi Constantini
  • Jonathan RothEmail author
Case Report

Abstract

Epilepsy and intracranial pressure (ICP) can be interrelated. While shunt malfunction is recognized as a cause of seizures, shunt over-drainage is seldom reported as such. We report a child who had undergone ventriculoperitoneal shunt insertion at the age of 6 months following an excision of a left ventricle choroid plexus papilloma, who developed refractory epilepsy since the age of 3 years. An MRI showed small ventricles. The child presented with acute hydrocephalus due to proximal shunt malfunction at the age of 11 years and was treated with an endoscopic third ventriculostomy. Following the procedure, the seizures abated. Our case suggests that intractable epilepsy may be related to intracranial hypotension. Potential treatments for shunt over-drainage may be indicated even in the absence of classic over-drainage symptoms, in the presence of refractory epilepsy.

Keywords

Hydrocephalus Refractory epilepsy Ventriculoperitoneal shunt Over-drainage Endoscopic third ventriculostomy 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare they have no conflict of interest.

References

  1. 1.
    Kahle KT, Kulkarni AV, Limbrick DD Jr, Warf BC (2016) Hydrocephalus in children. Lancet 387:788–799CrossRefGoogle Scholar
  2. 2.
    Olivecrona M, Zetterlund B, Rodling-Wahlstrom M, Naredi S, Koskinen LO (2009) Absence of electroencephalographic seizure activity in patients treated for head injury with an intracranial pressure-targeted therapy. J Neurosurg 110:300–305CrossRefGoogle Scholar
  3. 3.
    Scheffer IE, Berkovic S, Capovilla G, Connolly MB, French J, Guilhoto L, Hirsch E, Jain S, Mathern GW, Moshe SL, Nordli DR, Perucca E, Tomson T, Wiebe S, Zhang YH, Zuberi SM (2017) ILAE classification of the epilepsies: position paper of the ILAE Commission for Classification and Terminology. Epilepsia 58:512–521CrossRefGoogle Scholar
  4. 4.
    Klepper J, Busse M, Strassburg HM, Sorensen N (1998) Epilepsy in shunt-treated hydrocephalus. Dev Med Child Neurol 40(11):731–736CrossRefGoogle Scholar
  5. 5.
    Johnson DL, Conry J, O'Donnell R (1996) Epileptic seizure as a sign of cerebrospinal fluid shunt malfunction. Pediatr Neurosurg 24(25):223–227CrossRefGoogle Scholar
  6. 6.
    Uchida D, Fujimoto A, Yamazoe T, Yamamoto T, Enoki H (2018) Seizure frequency can be reduced by changing intracranial pressure: a case report in drug-resistant epilepsy. Epilepsy Behav Case Rep 10:14–17CrossRefGoogle Scholar
  7. 7.
    Khan RB, Boop FA, Onar A, Sanford RA (2006) Seizures in children with low-grade tumors: outcome after tumor resection and risk factors for uncontrolled seizures. J Neurosurg 104:377–382Google Scholar
  8. 8.
    McNatt SA, Kim A, Hohuan D, Krieger M, McComb JG (2008) Pediatric shunt malfunction without ventricular dilatation. Pediatr Neurosurg 44:128–132CrossRefGoogle Scholar
  9. 9.
    Kim I, Torrey SB, Milla SS, Torch MC, Tunik MG, Foltin JC (2015) Benefits of brain magnetic resonance imaging over computed tomography in children requiring emergency evaluation of ventriculoperitoneal shunt malfunction: reducing lifetime attributable risk of cancer. Pediatr Emerg Care 31:239–242CrossRefGoogle Scholar
  10. 10.
    Saukkonen AL, Serlo W, von Wendt L (1988) Electroencephalographic findings and epilepsy in the slit ventricle syndrome of shunt-treated hydrocephalic children. Childs Nerv Syst 4(6):344–347CrossRefGoogle Scholar
  11. 11.
    Agrawal D, Durity FA (2006) Seizure as a manifestation of intracranial hypotension in a shunted patient. Pediatr Neurosurg 42(43):165–167CrossRefGoogle Scholar
  12. 12.
    Habibi Z, Nejat F, El Khashab M (2010) Possible causes of seizure after spine surgery. J Pediatr Neurosci 5:36–38CrossRefGoogle Scholar
  13. 13.
    Lin S, Tsou M, Chan K, Yin Y, Hsin S, Liao W, Mok M, Tsai S (2002) Myoclonic seizure in the postanesthesia care unit after thoracic laminectomy. Anesth Analg 95:777–779Google Scholar
  14. 14.
    Juge L, Pong AC, Bongers A, Sinkus R, Bilston LE, Cheng S (2016) Changes in rat brain tissue microstructure and stiffness during the development of experimental obstructive hydrocephalus. PLoS One 11:e0148652CrossRefGoogle Scholar
  15. 15.
    Oi S, Matsumoto S (1986) Morphological findings of postshunt slit-ventricle in experimental canine hydrocephalus. Aspects of causative factors of isolated ventricles and slit-ventricle syndrome. Childs Nerv Syst 2:179–184CrossRefGoogle Scholar
  16. 16.
    Buxton N, Punt J (1999) Subtemporal decompression: the treatment of noncompliant ventricle syndrome. Neurosurgery 44:513–518 discussion 518-519CrossRefGoogle Scholar
  17. 17.
    K Kondageski C, Thompson D, Reynolds M, Hayward RD (2007) Experience with the strata valve in the management of shunt overdrainage. J Neurosurg 106:195–102CrossRefGoogle Scholar
  18. 18.
    Sivaganesan A, Krishnamurthy R, Sahni D, Viswanathan C (2012) Neuroimaging of ventriculoperitoneal shunt complications in children. Pediatr Radiol 42:1029–1046CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Sackler School of MedicineTel-Aviv UniversityTel-AvivIsrael
  2. 2.Pediatric Neurology UnitWolfson Medical CenterHolonIsrael
  3. 3.Department of Pediatric NeurosurgeryDana Children’s Hospital, Tel Aviv Medical CenterTel AvivIsrael

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