The impact of hydrocephalus on pediatric epilepsy: insights from a single-center investigation

Abstract Background Hydrocephalus following intracerebral hemorrhage (ICH) is a common yet treatable complication. Despite its clinical significance, the long-term outcomes and predictive factors associated with hydrocephalus are not well understood, especially in pediatric population with epilepsy. This study aims to investigate the impact of hydrocephalus on children with epilepsy in Saudi Arabia. Methods This observational retrospective study was conducted at the pediatric neurology clinic of a tertiary care epilepsy center. Twenty-six patients diagnosed with comorbid hydrocephalus and epilepsy were included. Key variables analyzed included seizure characteristics, age at seizure onset, use of antiseizure medications, seizure control, long-term developmental outcomes (intellectual and motor), the timing of shunt insertion in relation to seizure onset, and focal EEG changes. Results Among the 26 patients, 61.5% ( n = 16) were males. A notable proportion, 57.7% ( n = 15), exhibited normal electroencephalogram (EEG) results, while 42.3% ( n = 11) presented with abnormal EEG patterns. Of the 26 patients, 38.4% ( n = 10) had congenital hydrocephalus, while 61.6% ( n = 16) had acquired hydrocephalus. Seizure frequency varied: 38.5% ( n = 10) experienced only once seizure, 11.5% ( n = 3) had one to four seizures per month and 3.8% ( n = 1) encountered two to four seizures per day. The majority of hydrocephalus cases (61.5%, n = 16) were diagnosed during infancy to two years of age. Shunt insertion was prevalent, with 80.7% ( n = 21) undergoing the procedure. Developmental delays were observed in 61.5% ( n = 16) of the patients. Conclusions This study highlights the important role of hydrocephalus in the context of epilepsy among children in Saudi Arabia. Further research with larger sample size is needed to confirm these findings and provide a basis for improved understanding and targeted interventions in this critical medical area.