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

Abstract

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.

Pediatric neurodevelopment by prenatal Zika virus exposure: A cross-sectional study of the Microcephaly Epidemic Research Group Cohort

“…It is not possible to determine whether the condition was resolved or if this behavior was modi ed by the frequent use of anticonvulsants in this population. 31 Also unexpectedly, children without microcephaly (Groups 3 and 4) demonstrated high frequencies of risk signs of behavioral and emotional symptoms (42.5% and 63.7%, respectively). Although the underlying cause in this cohort is currently unknown, we note that studies have shown a progressive increase of the prevalence of behavioral abnormalities in childhood worldwide [32][33][34] .…”

Pediatric neurodevelopment by prenatal Zika virus exposure: A cross-sectional study of the Microcephaly Epidemic Research Group Cohort

“…It is not possible to determine whether the condition was resolved or if this behavior was modi ed by the frequent use of anticonvulsants in this population. 31 Also unexpectedly, children without microcephaly (Groups 3 and 4) demonstrated high frequencies of risk signs of behavioral and emotional symptoms (42.5% and 63.7%, respectively). Although the underlying cause in this cohort is currently unknown, we note that studies have shown a progressive increase of the prevalence of behavioral abnormalities in childhood worldwide [32][33][34] .…”

Continuous epileptiform discharges during sleep as an evolutionary pattern in patients with congenital Zika virus syndrome

“…8,9 Due to the nature and severity of injuries to the CNS, epilepsy is a frequent finding and may lead to clinical deterioration. [10][11][12] Most clinical descriptions of CZVS are based on infants at an early age. At this stage of life, epilepsy occurs in 58.3%-71.4%.…”

“…[10][11][12] Epileptic spasms are the primary type of seizure during the first year of life, 11 whereas focal motor seizures prevail in the second year. 12 Despite the abundance of clinical data, in-depth descriptions of the electroencephalographic (EEG) pattern are scarce. 12 According to earlier studies, hypsarrhythmia, focal, and multifocal epileptiform discharges (ED) frequently occur in this phase of life.…”

“…12 Despite the abundance of clinical data, in-depth descriptions of the electroencephalographic (EEG) pattern are scarce. 12 According to earlier studies, hypsarrhythmia, focal, and multifocal epileptiform discharges (ED) frequently occur in this phase of life. 11,12 Currently, no studies have described the EEG patterns of patients with the Zika virus after infancy.…”