Motor Abnormalities and Epilepsy in Infants and Children With Evidence of Congenital Zika Virus Infection

Abstract

Initial reports of congenital Zika virus (ZIKV) infection focused on microcephaly at birth with severe brain anomalies; the phenotype has broadened to include microcephaly that develops after birth and neurodevelopmental sequelae. In this narrative review, we summarize medical literature describing motor abnormalities and epilepsy in infants with evidence of congenital ZIKV infection and provide information on the impact of these conditions. Specific scenarios are used to illustrate the complex clinical course in infants with abnormalities that are consistent with congenital Zika syndrome. A search of the English-language medical literature was done to identify motor abnormalities and epilepsy in infants with evidence of congenital ZIKV infection by using Medline and PubMed, Embase, Scientific Electronic Library Online, Scopus, the OpenGrey Repository, and the Grey Literature Report in Public Health. Search terms included "Zika" only and "Zika" in combination with any of the following terms: "epilepsy," "seizure," "motor," and "cerebral palsy." Clinical features of motor abnormalities and epilepsy in these children were reviewed. Thirty-six publications were identified; 8 were selected for further review. Among infants with clinical findings that are consistent with congenital Zika syndrome, 54% had epilepsy and 100% had motor abnormalities. In these infants, impairments that are consistent with diagnoses of cerebral palsy and epilepsy occur frequently. Pyramidal and extrapyramidal motor abnormalities were notable for their early development and co-occurrence. Prompt identification of potential disabilities enables early intervention to improve the quality of life for affected children. Long-term studies of developmental outcomes and interventions in children with congenital ZIKV infection are needed.

Zika virus during pregnancy: From maternal exposure to congenital Zika virus syndrome

“…Neurologic impairments such as swallowing dysfunction, movement abnormalities, and epilepsy have been described in infants suffering from CZS as well as in infants asymptomatic at birth …”

“…The predominant neurologic findings in young infants with suspected congenital ZIKV infection are extreme irritability, hyperreflexia, and hypertonia with spasticity, tremors, and extra‐pyramidal symptoms, hypotonia, or a combination of hyper‐ and hypotonia . Motor abnormalities affected 77.3% to 100% of infants with CZS at birth . Epilepsy is associated with 9% to 95.5% of congenital ZIKV infection …”

“…Motor abnormalities affected 77.3% to 100% of infants with CZS at birth . Epilepsy is associated with 9% to 95.5% of congenital ZIKV infection …”

“…80,81 Neurologic impairments such as swallowing dysfunction, movement abnormalities, and epilepsy have been described in infants suffering from CZS as well as in infants asymptomatic at birth. 82 The predominant neurologic findings in young infants with suspected congenital ZIKV infection are extreme irritability, hyperreflexia, and hypertonia with spasticity, tremors, and extrapyramidal symptoms, hypotonia, or a combination of hyper-and hypotonia. 36,63,83,84 Motor abnormalities affected 77.3% to 100% of infants with CZS at birth.…”

Congenital Zika Virus Infection in Immunocompetent Mice Causes Postnatal Growth Impediment and Neurobehavioral Deficits

“…Most importantly, recent evidence has surfaced that some normal appearing neonates born to ZIKV-infected pregnant women have developed postnatal microcephaly symptoms including brain neuroimaging abnormalities, head growth restrictions, and behavioral deficits months after birth (Licon, 2016; van der Linden et al, 2016). In addition, the complex involvement of co-morbid neurodevelopmental sequelae of infants that were exposed to ZIKV in utero has also been described in infants months to years after birth; for example, motor abnormalities, such as dyskinesia, hypertonia, and spasticity, have been observed together with seizures (Pessoa et al, 2018). In line with this, intra-amniotic infection of immunocompetent murine dams identified co-morbid motor deficits, such as rota-rod latency and gait/stride disturbances in pups, which may have been attributed to vision disparities (Cui et al, 2017).…”