Abstract
We explored the relationship between seizure activity (SA) and/or chronic epilepsy
(CE) and short-term neurodevelopmental outcomes following fetal myelomeningocele (fMMC)
surgery. Retrospective databases and a parental questionnaire focusing on common complications
of hindbrain herniation associated with MMC were used to determine the incidence of
seizures following fMMC surgery. The Bayley Scales of Infant Development II was used
to evaluate the neurocognitive outcomes. The available 3-year outcome data were used
for analysis. 54 children underwent fMMC closure at our institution between 1998 and
2003. 48 (89%) families participated. The shunt rate was 50% (n=24). Seizures developed
in 8/48 (17%) children, 2 (8%) non-shunted and 6 (25%) shunted (P=0.07). Of those
six, 3 developed CE. Neurodevelopmental scores in the average range were found in
both non-shunted and 3 shunted fMMC children. The remaining 3 shunted toddlers had
CE and significant neurodevelopmental delays. Of those, 2 had severe intracranial
hemorrhage and one developed frequent apneic spells in combination with epilepsy.
The incidence of seizures in fMMC children was similar to previously reported data
of postnatally repaired MMC patients. SA alone without CE was not associated with
a worse neurocognitive outcome. The occurrence of severe acquired intracranial injury
and CE, however, appeared to be correlated with adverse neurocognitive outcome following
fMMC surgery.
Key words
myelomeningocele - spina bifida - fetal surgery - seizure - epilepsy - neurodevelopmental
outcome - ventriculomegaly
References
Correspondence
johnsonma@email.chop.edu
