A guide for the use of fNIRS in microcephaly associated to congenital Zika virus infection

João Ricardo Sato,Suellen Marinho Andrade,Júlia De Souza Rodrigues,Elidianne Layanne Medeiros De Araújo,Claudinei Eduardo Biazoli Junior

doi:10.1038/s41598-021-97450-w

Abstract

Congenital Zika Syndrome (CZS) is characterized by changes in cranial morphology associated with heterogeneous neurological manifestations and cognitive and behavioral impairments. In this syndrome, longitudinal neuroimaging could help clinicians to predict developmental trajectories of children and tailor treatment plans accordingly. However, regularly acquiring magnetic resonance imaging (MRI) has several shortcomings besides cost, particularly those associated with childrens' clinical presentation as sensitivity to environmental stimuli. The indirect monitoring of local neural activity by non-invasive functional near-infrared spectroscopy (fNIRS) technique can be a useful alternative for longitudinally accessing the brain function in children with CZS. In order to provide a common framework for advancing longitudinal neuroimaging assessment, we propose a principled guideline for fNIRS acquisition and analyses in children with neurodevelopmental disorders. Based on our experience on collecting fNIRS data in children with CZS we emphasize the methodological challenges, such as clinical characteristics of the sample, desensitization, movement artifacts and environment control, as well as suggestions for tackling such challenges. Finally, metrics based on fNIRS can be associated with established clinical metrics, thereby opening possibilities for exploring this tool as a long-term predictor when assessing the effectiveness of treatments aimed at children with severe neurodevelopmental disorders.

Highlights

Zika virus is a flavivirus, in the family Flaviviridae transmitted by mosquitoes of the genus Aedes sp
Congenital Zika Syndrome (CZS) is characterized by changes in cranial morphology associated with heterogeneous neurological manifestations and cognitive and behavioral impairments
Repeated follow-up Magnetic Resonance Imaging (MRI) acquisitions could potentially provide clinically significant information to guide care and recovery strategies, important shortcomings preclude the use of frequent MRI in children with CZS

Summary

Introduction

Zika virus is a flavivirus, in the family Flaviviridae transmitted by mosquitoes of the genus Aedes sp. Congenital Zika Syndrome (CZS) is characterized by changes in cranial morphology associated with heterogeneous neurological manifestations and cognitive and behavioral impairments. Structural and functional neuroimaging studies might be critical tools to inform long-lasting clinical care of CZS patients. The risk of worsening neurological impairment by repeatedly sedating children for follow-up neuroimaging studies would far outweigh the potential benefits. Available protocols to avoid sedation in pediatric patients undergoing MRI scanning[17] would not be feasibly applied for most children with CZS given the clinical features highlighted above. Added to the relatively high cost of MRI, these characteristics foreclose the possibility of applying this neuroimaging modality for the longitudinal follow up of children with CZS and microcephaly. The feasibility and potentiality of measuring neuro-hemodynamic activity during development in patients with microcephaly associated with the Zika virus remains to be investigated. To the best of our knowledge, no studies to date have recorded fNIRS signals on children with CZV

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