Brain Magnetic Resonance Imaging Findings of Congenital Cytomegalovirus Infection as a Prognostic Factor for Neurological Outcome

Kwak, Min‐Sun; Yum, Mi‐Sun; Yeh, Hye-Ryun; Kim, Hyun‐Jin; Ko, Tae‐Sung

doi:10.1016/j.pediatrneurol.2018.03.008

Cited by 49 publications

(32 citation statements)

References 28 publications

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“…Although we also observed that the incidence of adverse neurological outcome was associated with gestational age and birth weight in the current study, the differences in the adverse neurological outcome group compared to the favorable outcome group were not significant, which might be due to our inclusion criterion of gestational age ≥35 weeks. Additionally, our study also confirmed previous observations that the likelihood of suffering adverse neurological outcomes increases in those born with congenital or metabolic diseases …”

Section: Discussioncontrasting

confidence: 70%

“…Additionally, our study also confirmed previous observations that the likelihood of suffering adverse neurological outcomes increases in those born with congenital or metabolic diseases. 48 The primary limitation of this work may be that the timing of aEEG took little consideration that different therapeutic strategies, for example, hypothermia, might affect the efficacy of the prognostic value of aEEG. Another limitation might be our imbalanced proportion of infants suffering from HIE (96, 38.4%), which might be the reason that our current results are inconsistent with our previous study showing that undesirable antepartum or intrapartum events are risk factors for adverse neurological deficits.…”

Section: Discussionmentioning

confidence: 99%

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Prognostic value of amplitude‐integrated EEG in neonates with high risk of neurological sequelae

Xiao

Kang

Shi

et al. 2020

Ann Clin Transl Neurol

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Objective To determine the efficacy and the prognostic value of amplitude‐integrated electroencephalography (aEEG) in term and near‐term neonates with high risk of neurological sequelae. Methods Infants of ≥35 weeks of gestation diagnosed with neonatal encephalopathy or with high risk of brain injury were included. All eligible infants underwent aEEG within 6 h after clinical assessment. The infants were followed up 12 months to evaluate neurological development. Results A total of 250 infants were eligible, of which 85 had normal aEEG, 81 had mildly abnormal aEEG, and 84 had severely abnormal aEEG. Of these infants, 168 were diagnosed with different neonatal encephalopathies, 27 with congenital or metabolic diseases, and 55 with high risk of brain injury. In all, 22 infants died, 19 were lost to follow‐up, and 209 completed the follow‐up at 12 months, of which 62 were diagnosed with a neurological disability. Statistical analysis showed that severely abnormal aEEG predicted adverse neurological outcome with a sensitivity of 70.2%, a specificity of 87.1%, a positive predictive value of 75.6%, and a negative predictive value of 83.7%. Interpretation aEEG can predict adverse outcomes in high‐risk neonates and is a useful method for monitoring neonates with high risk of adverse neurological outcomes.

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Section: Discussioncontrasting

confidence: 70%

Section: Discussionmentioning

confidence: 99%

Prognostic value of amplitude‐integrated EEG in neonates with high risk of neurological sequelae

Xiao

Kang

Shi

et al. 2020

Ann Clin Transl Neurol

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“…The incidence of congenital cytomegalovirus‐associated epilepsy has been reported to vary between 10% and 56%, and the emergence of seizures has been linked to disorders of cortical development, ventriculomegaly, and calcifications. In contrast with CZS cases, focal seizures are the most common type associated with congenital cytomegalovirus infections . As the developmental cortical disorders in the current ZIKV cohort were severe and extensive, this finding may, in part, explain the observed higher incidence and greater severity of epilepsy relative to published reports on congenital cytomegalovirus‐associated epilepsy …”

Section: Discussionmentioning

confidence: 51%

“…In contrast with CZS cases, focal seizures are the most common type associated with congenital cytomegalovirus infections. 37,38 As the developmental cortical disorders in the current ZIKV cohort were severe and extensive, this finding may, in part, explain the observed higher incidence and greater severity of epilepsy relative to published reports on congenital cytomegalovirus-associated epilepsy. 37 The role of ZIKV in epileptogenesis is not yet fully understood, but it is well established that congenital infections can lead to structural abnormalities in brain tissue.…”

Section: T a B L E 3 Clinical And Eegmentioning

confidence: 65%

Early epilepsy in children with Zika‐related microcephaly in a cohort in Recife, Brazil: Characteristics, electroencephalographic findings, and treatment response

et al. 2020

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Objective To estimate the incidence of epilepsy in children with Zika‐related microcephaly in the first 24 months of life; to characterize the associated clinical and electrographic findings; and to summarize the treatment responses. Methods We followed a cohort of children, born during the 2015‐2016 Zika virus (ZIKV) epidemic in Brazil, with congenital microcephaly and evidence of congenital ZIKV infection on neuroimaging and/or laboratory testing. Neurological assessments were performed at ≤3, 6, 12, 15, 18, 21, and 24 months of life. Serial electroencephalograms were performed over the first 24 months. Results We evaluated 91 children, of whom 48 were female. In this study sample, the cumulative incidence of epilepsy was 71.4% in the first 24 months, and the main type of seizure was infantile spasms (83.1%). The highest incidence of seizures occurred between 3 and 9 months of age, and the risk remained high until 15 months of age. The incidence of infantile spasms peaked between 4 and 7 months and was followed by an increased incidence of focal epilepsy cases after 12 months of age. Neuroimaging results were available for all children, and 100% were abnormal. Cortical abnormalities were identified in 78.4% of the 74 children evaluated by computed tomography and 100% of the 53 children evaluated by magnetic resonance imaging. Overall, only 46.1% of the 65 children with epilepsy responded to treatment. The most commonly used medication was sodium valproate with or without benzodiazepines, levetiracetam, phenobarbital, and vigabatrin. Significance Zika‐related microcephaly was associated with high risk of early epilepsy. Seizures typically began after the third month of life, usually as infantile spasms, with atypical electroencephalographic abnormalities. The seizure control rate was low. The onset of seizures in the second year was less frequent and, when it occurred, presented as focal epilepsy.

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“…In previous studies, poor neurodevelopmental outcomes such as hearing loss, loss of vision, chorioretinitis, microcephaly, cognitive disorders, and cerebral palsy were reported in infants with congenital CMV infection who were whether symptomatic or asymptomatic and developed the findings within the 1st year of life. 3,4 Nevertheless, it is still controversial to predict which babies will have a developmental disorder. In the literature, there are studies concerning computed tomography (CT) images showing destructive brain lesions associated with poor neurological outcomes 5 and MR images showing white matter and migration abnormalities 4 in patients with congenital CMV infection.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Clinical and Neuroimaging Characteristics of Congenital and Possible Congenital Cytomegalovirus Infected Infants: A Retrospective Study

Tarakçı

Bulut

Çaksen

et al. 2018

J Pediatr Infect Dis

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Background To evaluate clinical and neurodevelopmental outcomes and neuroimaging results of patients diagnosed with congenital cytomegalovirus (cCMV) infection and those diagnosed with possible congenital CMV (possible cCMV) infection. Methods From January 2014 to January 2016, 24 patients were diagnosed with congenital CMV infection. Clinical and neuroimaging results of these patients were examined from their medical records. Results Of the 24 patients, 6 were diagnosed with cCMV, whereas 18 patients were diagnosed with possible cCMV. Petechia was the most common symptom observed in patients with cCMV infection, whereas microcephaly was more common in patients with possible cCMV. Of the 24 patients, 5 (20.8%) showed normal neuroimaging characteristics. The most commonly encountered abnormal findings in brain magnetic resonance imaging were hypoplasia of corpus callosum (16.7%) and hydrocephalous (16.7%). All of the patients had poor neurodevelopmental outcomes. Conclusions Early diagnosis of asymptomatic cCMV infection is difficult. This study suggests that possible cCMV infections are more prevalent compared with cCMV infections, and delays in diagnosis occur due to not keeping suspicion of CMV infection in early phase. Clinicians should consider long-term neurodevelopmental sequelae of cCMV and possible cCMV infections and remember to screen congenital CMV infection in suspected individuals.

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Brain Magnetic Resonance Imaging Findings of Congenital Cytomegalovirus Infection as a Prognostic Factor for Neurological Outcome

Cited by 49 publications

References 28 publications

Prognostic value of amplitude‐integrated EEG in neonates with high risk of neurological sequelae

Prognostic value of amplitude‐integrated EEG in neonates with high risk of neurological sequelae

Early epilepsy in children with Zika‐related microcephaly in a cohort in Recife, Brazil: Characteristics, electroencephalographic findings, and treatment response

Comparison of Clinical and Neuroimaging Characteristics of Congenital and Possible Congenital Cytomegalovirus Infected Infants: A Retrospective Study

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