Disabilities in Children with Hydrocephalus - A Population-Based Study of Children Aged Between Four and Twelve Years

Abstract

Background: Children with hydrocephalus represent a heterogeneous group with various aetiologies and disability profiles. Over the years, continuous changes in medical care have occurred and updated information is important. Aim: To study disability profiles in aetiological and gestational age subgroups of children with hydrocephalus in the 1990s. Method: A population-based series of 114 children, 70 with infantile hydrocephalus and 44 with hydrocephalus associated with MMC. All the children were examined clinically and interviewed. Results: Learning disabilities were present in 47 % of children with infantile hydrocephalus compared with 16 % of those with MMC, cerebral palsy in 27 % vs. zero and epilepsy in 34 vs. 11 %. Even after excluding children with cerebral palsy, the majority had abnormal tendon reflexes and scored below the 5th centile on a motor test. Hydrocephalus overt at birth, low gestational age, a perinatal origin, enlarged ventricles at follow-up and several shunt revisions all indicated risk factors for a poor outcome. Conclusions: In spite of major advances in management, hydrocephalus in children still has a considerable impact on outcome. Being born very preterm and with a hydrocephalus that is already overt at birth involve the highest risk of a poor outcome. Apart from major impairments, the children frequently have definite motor problems.

Key words

Hydrocephalus - myelomeningocele - disability - population-based

References

• 1 Bowman R M, McLone D G, Grant J A, Tomita T, Ito J A. Spina Bifida Outcome: A 25 year prospective.  Pediatr Neurosurg. 2001;  34 114-120
• 2 Casey A T, Kimmings E J, Kleinlugtebeld A D, Taylor W A, Harkness W F, Hayward R D. The long-term outlook for hydrocephalus in childhood. A ten-year cohort study of 155 patients.  Pediatr Neurosurg. 1997;  27 63-70
• 3 Fernell E, Hagberg B, Hagberg G, von Wendt L. Epidemiology of infantile hydrocephalus in Sweden. I. Birth prevalence and general data.  Acta Paediatr Scand. 1986;  75 975-981
• 4 Fernell E, Uvebrant P, von Wendt L. Overt hydrocephalus at birth - origin and outcome.  Childs Nerv Syst. 1987;  3 350-353
• 5 Fernell E, Hagberg G, Hagberg B. Infantile hydrocephalus epidemiology: an indicator of enhanced survival.  Arch Dis Child. 1994;  70 F123-F128
• 6 Futagi Y, Suzuki Y, Toribe Y, Morimoto K. Neurodevelopmental outcome in children with fetal hydrocephalus.  Pediatr Neurol. 2002;  27 111-116
• 7 Heinsbergen I, Rotteveel J, Roeleveld N, Grotenhuis A. Outcome in shunted hydrocephalic children.  Eur J Paediatr Neurol. 2002;  6 99-107
• 8 Henderson S E, Sugden D A. Movement Assessment Battery for Children: Manual. San Antonio, Texas; The Psychological Corporation, Ltd. 1992
• 9 Hoppe-Hirsch E, Laroussinie F, Brunet L, Sainte-Rose C, Renier D, Cinalli G. et al . Late outcome of the surgical treatment of hydrocephalus.  Childs Nerv Syst. 1998;  14 97-99
• 10 Kirkinen P, Serlo W, Jouppila P, Ryynanen M, Martikainen A. Long-term outcome of fetal hydrocephaly.  J Child Neurol. 1996;  11 189-192
• 11 Lindquist B, Carlsson G, Persson E K, Uvebrant P. Learning disabilities in a population-based group of children with hydrocephalus.  Acta Paediatr. 2005;  94 878-883
• 12 Lindquist B, Carlsson G, Persson E K, Uvebrant P. Behavioural problems and autism in children with hydrocephalus: a population-based study.  Eur Child Adolesc Psychiatry. 2006;  15 214-219
• 13 Lumenta C B, Skotarczak U. Long-term follow-up in 233 patients with congenital hydrocephalus.  Childs Nerv Syst. 1995;  11 173-175
• 14 Lundberg A. Gross and fine motor performance in healthy Swedish children aged fifteen and eighteen months.  Neuropädiatrie. 1979;  10 11-24
• 15 Meyer-Heim A D, Klein A, Boltshauser E. Cervical myelomeningocele - follow-up of five patients.  Eur J Paediatr Neuro. 2003;  7 407-412
• 16 Mirzai H, Ersahin Y, Mutluer S, Kayahan A. Outcome of patients with meningomyelocele: the Ege University experience.  Childs Nerv Syst. 1998;  14 120-123
• 17 Mori K, Shimada J, Kurisaka M, Sato K, Watanabe K. Classification of hydrocephalus and outcome of treatment.  Brain Dev. 1995;  17 338-348
• 18 Mutch L, Alberman E, Hagberg B, Kodama K, Perat M V. Cerebral palsy epidemiology: where are we now and where are we going?.  Dev Med Child Neurol. 1992;  34 547-551
• 19 Norrlin S, Strinnholm M, Carlsson M, Dahl M. Factors of significance for mobility in children with myelomeningocele.  Acta Paediatr. 2003;  92 204-210
• 20 Persson E K, Hagberg G, Uvebrant P. Hydrocephalus prevalence and outcome in a population-based cohort of children born in 1989 - 1998.  Acta Paediatr. 2005;  94 726-732
• 21 Resch B, Gedermann A, Maurer U, Ritschl E, Muller W. Neurodevelopmental outcome of hydrocephalus following intra-/periventricular hemorrhage in preterm infants: short- and long-term results.  Childs Nerv Syst. 1996;  12 27-33
• 22 Riva D, Milani N, Giorgi C, Pantaleoni C, Zorzi C, Devoti M. Intelligence outcome in children with shunted hydrocephalus of different etiology.  Childs Nerv Syst. 1994;  10 70-73
• 23 Saukkonen A L, Serlo W, von Wendt L. Epilepsy in hydrocephalic children.  Acta Paediatr Scand. 1990;  79 212-218
• 24 Turner A. Upper-limb function of children with myelomeningocele.  Dev Med Child Neurol. 1986;  28 790-798
• 25 World Health Organization .International Classification of Impairments, Disabilities and Handicaps. Geneva; World Health Organization 1980