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

Maria Eulina Quilião,Everton Falcão De Oliveira,Lisany Krug Mareto,Fabio Antonio Venancio,Daniele Cristina Vitorelli-Venancio,Cláudia Du Bocage Santos-Pinto,Sahra De Almeida Metzker,Ana Isabel Do Nascimento

doi:10.3390/v12101083

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.

Highlights

Our study aimed to describe the results from a two-year follow-up of a cohort of children diagnosed with congenital Zika syndrome (CZS) related to the growth of head circumference and some neurological and motor outcomes
Congenital Zika syndrome remains a public health problem, and due to the current age of these children who were exposed to Zika virus (ZIKV) during the intrauterine period, the late outcomes are still not fully characterized [4,36]
We describe the results of the second year of a longitudinal follow-up of a cohort of children with CZS

Summary

Introduction

Zika virus (ZIKV) infection can result in unexpected neurological diseases and congenital malformations, with severe consequences for children exposed to prenatal ZIKV infection [1] and other outcomes in adults ranging from temporary mental confusion and motor disabilities to more severe outcomes, such as coma or memory loss [2].Viruses 2020, 12, 1083; doi:10.3390/v12101083 www.mdpi.com/journal/virusesStudies carried out between 2017 and 2019 indicate that there are approximately 5000 cases of children with congenital Zika syndrome (CZS) worldwide, distributed in 31 countries or territories [3,4].In Brazil, the country with the highest number of cases, 3496 cases of CZS were confirmed in live-born babies, and 2665 children remain under investigation as of May 2020 [5].The term CZS was adopted to describe a series of alterations in fetuses and live-born babies exposed to ZIKV during pregnancy. Studies carried out between 2017 and 2019 indicate that there are approximately 5000 cases of children with congenital Zika syndrome (CZS) worldwide, distributed in 31 countries or territories [3,4]. In Brazil, the country with the highest number of cases, 3496 cases of CZS were confirmed in live-born babies, and 2665 children remain under investigation as of May 2020 [5]. The term CZS was adopted to describe a series of alterations in fetuses and live-born babies exposed to ZIKV during pregnancy. Other outcomes were observed and added to the definition of CZS, such as severe microcephaly with partially collapsed skull [11,12], ocular alterations [13,14] and congenital contractures [15], hydrocephalus [16], craniofacial disproportion [17], muscle tone, postural alterations, marked early hypertonia and symptoms of extrapyramidal involvement [13,18,19], pseudobulbar syndrome [20], and postnatal microcephaly [20,21,22]

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