Neurological Development, Epilepsy, and the Pharmacotherapy Approach in Children with Congenital Zika Syndrome: Results from a Two-Year Follow-up Study

Abstract

Clinical outcomes related to congenital Zika syndrome (CZS) include microcephaly accompanied by specific brain injuries. Among several CZS outcomes that have been described, epilepsy and motor impairments are present in most cases. Pharmacological treatment for seizures resulting from epilepsy is performed with anticonvulsant drugs, which in the long term are related to impairments in the child’s neuropsychomotor development. Here, we describe the results from a two-year follow-up of a cohort of children diagnosed with CZS related to the growth of the head circumference and some neurological and motor outcomes, including the pharmacological approach, and its results in the treatment of epileptic seizures. This paper is part of a prospective cohort study carried out in the state of Mato Grosso Sul, Brazil, based on a Zika virus (ZIKV)-exposed child population. Our data were focused on the assessment of head circumference growth and some neurological and motor findings, including the description of seizure conditions and pharmacological management in two periods. Among the 11 children evaluated, 8 had severe microcephaly associated with motor impairment and/or epilepsy. Seven children were diagnosed with epilepsy. Of these, 3 had West syndrome. In four children with other forms of epilepsy, there was no pharmacological control.

Congenital Zika Infection and the Risk of Neurodevelopmental, Neurological, and Urinary Track Disorders in Early Childhood. A Systematic Review

“…The head circumference at birth for children with microcephaly has also been associated with severe neurodevelopmental delay, severe neuroimaging findings, dysphagia, spasticity, hyperreflexia, hearing loss and epilepsy, according to the Garcia-Boyano et al (2020) cohort study [ 33 ]. A cohort study of Quilião et al published in 2020 [ 34 ] describes the findings of a cohort of children with CZS in terms of their head circumference and neurological-neurodevelopmental outcomes. The results showed that the majority of children with severe microcephaly developed motor dysfunction and/or epilepsy, compared to children who were normocephalic.…”

“…Severe neurological and neurodevelopment outcomes were a more frequent sign in children born with microcephaly. More specifically, there is a strong correlation between the severity of the outcomes with a lower birth head circumference [ 26 , 28 , 29 , 30 , 31 , 34 ]. Of course, microcephaly of any type is considered a major driver of neurology and neurodevelopment delays [ 43 ].…”

Neurological evaluation of microcephalic children with Zika syndrome and congenital cytomegalovirus infection

“…In Quilião et al ‘s study [ 23 ], among the 11 evaluated children, 8 presented acute microcephaly associated with motor disability and/or epilepsy. It was observed that children with less motor impairment had minor relative change in head circumference, normal electroencephalogram tracing and absence of seizures [ 23 ].…”

“…In Quilião et al ‘s study [ 23 ], among the 11 evaluated children, 8 presented acute microcephaly associated with motor disability and/or epilepsy. It was observed that children with less motor impairment had minor relative change in head circumference, normal electroencephalogram tracing and absence of seizures [ 23 ]. In this study, 100% of children with GMFCS classification I and II had lower values of Z score of cephalic perimeter when compared to other classifications and the patients with more acute GMFCS levels were more likely to be epileptic.…”

Mortality from Congenital Zika Syndrome — Nationwide Cohort Study in Brazil

“…Although most fetuses with prenatal ZIKV exposure present no detectable clinical anomalies, a subset of congenitally infected offspring can have mild, moderate or severe adverse outcomes 2 collectively referred to as congenital Zika syndrome (CZS) 3 , 4 . The CZS phenotype encompasses a wide spectrum of structural anomalies (e.g., cortical atrophy with microcephaly 5 ), functional impairments (e.g., dysphagia 6 ), and clinical sequelae (e.g., epilepsy 7 , 8 ) that may manifest either at birth or in early life 9 . The prognosis for live births with CZS is not fully described; however, the most severe phenotype seems to be associated with first-trimester exposure 10 and one important prognostic factor is the severity of microcephaly 11 .…”