The role of ventricular shunts as a cause of seizures in children with hydrocephalus was studied in 190 patients treated for myelomeningoele in the Dept of Neurosurgery, Arkansas Children's Hospital, Little Rock, AR. The period of follow-up was 1-26 yrs, with an average of 9 yrs. The frequency of seizures in 144 shunted compared to 46 nonshunted patients was 22% and 2%, respectively. If modification of the shunt was unnecessary, only 9% had seizures, whereas in those requiring modification the incidence was 22%. A shunt infection raised the risk of seizures to 47%. Seizure frequency was approximately the same in those with frontal or parietal location catheters, 20 and 26%, respectively. Of 7 patients with unorthodox locations of shunt placements, near the motor cortex, 4(57%) developed seizures. 
COMMENT. One in four infants with myelomeningocele who are shunted for hydrocephalus develop seizures. Cortical injury at the time of shunt placement is a likely factor in etiology, and a complicating bacterial infection, even low-grade in type, will lead to diffuse cerebral injury and will double the risk of seizures. Candida meningitis has been reported in patients with CSF shunts , and a single colony of yeast should not be considered a contaminant especially in infants with hydrocephalus, ventricular shunts and cranial nerve palsies . McLone et al (Pediatrics 1982;70:338) have alluded to the effect of CNS infections on the intelligence of children with myelomeningocele, and the occurrence of seizures is a further complication of surgery. Delay in operative closure of the spina bifida may reduce the severity of hydrocephalus and lessen the need for shunting with its attendant risks (see Ped Neur Briefs 1988;2:52).