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Editor,—The use of a totally implantable venous access system (Port-A-Cath) in children has become widespread in the last 15 years. We report a series of three children for whom the Port-A-Cath improved management of their refractory seizures.
Two patients both females with a diagnosis of severe myoclonic epilepsy of infancy and recurrent status epilepticus presented in the first year of life. Both had seizures, which were intractable to multiple anticonvulsants and became refractory to benzodiazepines. Intravenous access was difficult, and to ease management of status epilepticus a Port-A-Cath was inserted at the age of 16 months in the first child and 13 months in the second. The third patient presented at 4 years with Lennox-Gastaut syndrome. Hospitalisation every 2–3 weeks became necessary for management of clusters of generalised tonic clonic seizures with intravenous medications. As seizures became resistant to multiple anticonvulsant therapies, intravenous immunoglobulin therapy once every 2 weeks was started with some success. Again venous access was difficult and a Port-A-Cath was implanted at 4½ years.
The first patient developed a candida albicans infection 9 months after insertion. Amphotericin B was given for 14 days and the Port-A-Cath removed. A second device was inserted after the infection was treated and remains in place 6 years later with no further complications. The second patient had her Port-A-Cath removed after 6 years and 5 months when the catheter blocked. A second device has just been inserted. The third patient has had no complications nine months after insertion.
Port-A-Cath devices are widely used in the management of children requiring venous access for longer than 3 months, when peripheral access is difficult and for administration of medications or blood products.1-4 Children who typically benefit have haemophilia, cystic fibrosis, or malignancies. To our knowledge, there has only been one previous reference to Port-A-Cath usage in neurological disease.2 In this study of 81 children, one child had the device inserted for home administration of medication. This was removed after a portal infection 3 months after insertion.2
The benefits to a Port-A-Cath include rapid reliable venous access, low maintenance, fewer restrictions on lifestyle, low incidence of infection and malfunction, when compared with externalised systems.3 These benefits are attractive for children with a refractory seizure disorder and their families. Rapid venous access is invaluable to the physician when managing status epilepticus.