The Burden of Epilepsy in Children with Myelomeningocele

Introduction: Children with myelomeningocele (MM) have an elevated risk of epilepsy, yet factors contributing to seizure development are not well elucidated. The objective of this abstract is to determine factors that predict epilepsy risk in MM patients

Methods: We conducted a retrospective review at a single multidisciplinary pediatric spina bifida clinic from 2002 to 2024. Chart review abstracted relevant patient demographics and clinical data. We compared patients with and without epilepsy, analyzing categorical and continuous variables using the Fisher's Exact test and Student's T-test, respectively.

Results: 161 patients were identified, with a mean age of 10.6 years, including 24 (14.9%) with epilepsy. There was no statistically significant difference between the two groups in terms of sex, race, ethnicity, social vulnerability index, gestational age at birth, birth weight, delivery method. On average, patients with epilepsy had a longer follow up duration (11.9 vs. 9.4 years, P=0.03), more frequently had a thoracolumbar MM (16.7% vs. 1.5%, P=0.005), and were more likely to have a ventricular shunt (95.8% vs. 69.3%, P=0.005). However, the groups did not differ by age at shunt insertion, number of revisions, history of shunt infections, history of endoscopic third ventriculostomy, meningitis, intraventricular hemorrhage, or fetal MM repair. Preliminary radiographic analysis indicates an increased prevalence of falx dysgenesis in the epilepsy cohort.

Conclusion : Nearly 15% of patients seen with MM at our center have epilepsy. Epilepsy was more common in thoracolumbar lesions and those that have a ventricular shunt; however, shunt related complications did not seem to increase the risk of developing epilepsy. The patients with epilepsy had a higher rate of falx dysgenesis which is commonly seen in the spectrum of Chiari II malformation. It is likely that some anatomic and functional effects from low intracranial pressure during fetal development can lead to the development of epilepsy in children with MM.