Continuous epileptiform discharges are associated with worse neurodevelopmental findings in a congenital Zika syndrome prospective cohort

• Published in: Seizure (London, England) England), 2024-05, Vol.118, p.148-155
• Main Authors: Campos, Marcos Adriano Garcia, Sousa, Patrícia da Silva, Cavalcante, Tamires Barradas, Takahasi, Eliana Harumi Morioka, Costa, Luciana Cavalcante, Ribeiro, Marizélia Rodrigues Costa, Costa, Elaine de Paula Fiod, Amaral, Gláucio Andrade, Vissoci, João Ricardo Nickenig, Silva, Antônio Augusto Moura da
• Format: Article
• Language: English
• Subjects: Child, Preschool; Congenital Zika syndrome; Continuous activity; Electroencephalography; Epilepsy - physiopathology; Female; Humans; Infant; Male; Microcephaly - diagnostic imaging; Microcephaly - physiopathology; Neurodevelopmental Disorders - etiology; Neurodevelopmental Disorders - physiopathology; Prospective Studies; Refractory epilepsy; Zika Virus Infection - complications; Zika Virus Infection - congenital; Zika Virus Infection - physiopathology
• ISSN: 1059-1311; 1532-2688
• DOI: 10.1016/j.seizure.2024.04.022

•Continuous epileptiform activity identified up to 24 months are associated with worse findings in children with congenital Zika syndrome.•Children with congenital Zika syndrome and continuous epileptiform activity have drug-resistant epilepsy more frequently.•Bilateral continuous epileptiform discharges are more common and may indicate a specific pattern of congenital Zika syndrome encephalopathy. This study aimed to identify continuous epileptiform discharges (CEDs) on electroencephalograms (EEG) and to determine their clinical significance in children with congenital Zika syndrome (CZS). This prospective cohort study included 75 children diagnosed with CZS born from March 2015 and followed up until September 2018 (age up to 36 months). EEG was performed to detect CEDs up to 24 months old. Data on obstetric, demographic, and clinical signs; cranial computed tomography (CT); ophthalmology examination; anti-seizure medication; growth; and motor development were collected. Fisher's exact test was used to verify the associations between categorical variables, and the T- test was used to compare the mean z-scores of anthropometric measurements between the groups with and without CED. CEDs were identified in 41 (54.67 %) children. The mean age of CEDs identification was 12.24 ± 6.86 months. Bilateral CEDs were shown in 62.89 % of EEGs. CEDs were associated with severe congenital microcephaly, defined by z-score >3 standard deviation of head circumference (HC) below the mean for sex and age (p = 0.025), and worse outcomes, including first seizure before 6 months (p = 0.004), drug-resistant epilepsy (p < 0.001), chorioretinal scarring or mottling (p = 0.002), and severe CT findings (p = 0.002). The CED group had lower mean z-scores of HC up to 24 months of age. This is the first description of the prevalence and significance of CEDs that also remains during wakefulness in patients with CZS. New investigations may suggest that it is more appropriate to classify the EEG not as a CED, but as a periodic pattern. Anyway, CEDs may be a marker of neurological severity in children with CSZ.