Via NEJM: Epilepsy Profile in Infants with Congenital Zika Virus Infection. Excerpt:
Congenital Zika virus (ZIKV) infection may have severe clinical consequences, including dysmorphic features, orthopedic abnormalities, ophthalmologic and auditory lesions, microcephaly, and hydrocephalus. When ZIKV infection is acquired in utero, it may be associated with epilepsy, and we characterized aspects of this complication in a study performed at our referral center.
Patients who were referred to our center had congenital or acquired microcephaly, were asymptomatic or symptomatic newborns who were born to mothers who had confirmed or suspected ZIKV infection during pregnancy, had calcifications (not related to other in utero infections) that were detected by means of neuroimaging studies, or had an unexplained developmental delay and lived in geographic regions where ZIKV infection was epidemic (see Table S2 in the Supplementary Appendix, available with the full text of this letter at NEJM.org).
Our study included 141 infants, 54.6% of whom were girls, who had congenital ZIKV infection that was confirmed by laboratory analysis. The mean age of the patients was 9 months (range, 1 to 14). Serum samples obtained from the infants and their mothers and samples of cerebrospinal fluid obtained from the infants were tested by means of quantitative reverse-transcriptase–polymerase-chain-reaction assay for the detection of the ZIKV genome and by an IgM antibody capture determined by enzyme-linked immunosorbent assay. In all the infants, structural brain abnormalities were detected by means of neuroimaging studies. The study was approved by the institutional review board of our referral center, and written informed consent was obtained from the parents of the infants.
The study protocol included a clinical evaluation every other month and immediate assessment in case of the development of unexpected clinical complications. The parents were interviewed with the use of a questionnaire that addressed clinical variables associated with epilepsy. Medical records, electroencephalography (EEG), video EEG, and videos from the families of the patients that documented seizures corroborated this information. Seizures were classified according to the guidelines of the International League against Epilepsy.
The prevalence of epilepsy in this cohort was 67%, and the mean age of the infants at the onset of epilepsy was 4.9 months. Data from the parents of the infants indicated that the seizures occurred during the first 6 months of life in 74% of the infants. At the onset of epilepsy and during follow-up, the main seizure types were epileptic spasms (in 72% of the infants), focal motor seizures (in 21%), and tonic seizures (in 4%) (Table 1). A single seizure type was documented in 77% of the infants.
