The Incidence of Postoperative Seizures Following Treatment of Postinfectious Hydrocephalus in Ugandan Infants: A Post Hoc Comparison of Endoscopic Treatment vs Shunt Placement in a Randomized Controlled Trial

Maria Punchak, Edith Mbabazi Kabachelor, Michael Ogwal, Esther Nalule, Joyce Nalwoga, Peter Ssenyonga, John Mugamba, Abbas Rattani, Michael C. Dewan, Abhaya V. Kulkarni, Steven J. Schiff, Benjamin Warf

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)E714-E721
JournalClinical Neurosurgery
Volume85
Issue number4
DOIs
StatePublished - Oct 1 2019

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Hydrocephalus
Seizures
Randomized Controlled Trials
Ventriculostomy
Cautery
Ventriculoperitoneal Shunt
Choroid Plexus
Incidence
Therapeutics
Epilepsy
Head
Weights and Measures

All Science Journal Classification (ASJC) codes

  • Surgery
  • Clinical Neurology

Cite this

Punchak, Maria ; Mbabazi Kabachelor, Edith ; Ogwal, Michael ; Nalule, Esther ; Nalwoga, Joyce ; Ssenyonga, Peter ; Mugamba, John ; Rattani, Abbas ; Dewan, Michael C. ; Kulkarni, Abhaya V. ; Schiff, Steven J. ; Warf, Benjamin. / The Incidence of Postoperative Seizures Following Treatment of Postinfectious Hydrocephalus in Ugandan Infants : A Post Hoc Comparison of Endoscopic Treatment vs Shunt Placement in a Randomized Controlled Trial. In: Clinical Neurosurgery. 2019 ; Vol. 85, No. 4. pp. E714-E721.
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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.",
author = "Maria Punchak and {Mbabazi Kabachelor}, Edith and Michael Ogwal and Esther Nalule and Joyce Nalwoga and Peter Ssenyonga and John Mugamba and Abbas Rattani and Dewan, {Michael C.} and Kulkarni, {Abhaya V.} and Schiff, {Steven J.} and Benjamin Warf",
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The Incidence of Postoperative Seizures Following Treatment of Postinfectious Hydrocephalus in Ugandan Infants : A Post Hoc Comparison of Endoscopic Treatment vs Shunt Placement in a Randomized Controlled Trial. / Punchak, Maria; Mbabazi Kabachelor, Edith; Ogwal, Michael; Nalule, Esther; Nalwoga, Joyce; Ssenyonga, Peter; Mugamba, John; Rattani, Abbas; Dewan, Michael C.; Kulkarni, Abhaya V.; Schiff, Steven J.; Warf, Benjamin.

In: Clinical Neurosurgery, Vol. 85, No. 4, 01.10.2019, p. E714-E721.

Research output: Contribution to journalArticle

TY - JOUR

T1 - The Incidence of Postoperative Seizures Following Treatment of Postinfectious Hydrocephalus in Ugandan Infants

T2 - A Post Hoc Comparison of Endoscopic Treatment vs Shunt Placement in a Randomized Controlled Trial

AU - Punchak, Maria

AU - Mbabazi Kabachelor, Edith

AU - Ogwal, Michael

AU - Nalule, Esther

AU - Nalwoga, Joyce

AU - Ssenyonga, Peter

AU - Mugamba, John

AU - Rattani, Abbas

AU - Dewan, Michael C.

AU - Kulkarni, Abhaya V.

AU - Schiff, Steven J.

AU - Warf, Benjamin

PY - 2019/10/1

Y1 - 2019/10/1

N2 - 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.

AB - 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.

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