Neurological evaluation of microcephalic children with Zika syndrome and congenital cytomegalovirus infection

The association between the virus prenatal infection by Zika virus (ZIKV) and central nervous system disorders has been well established and it has been described as the Congenital Syndrome Associated to the Zika Virus (CSZ). However, the neurological development in those patients is still an object of study. The main differential diagnosis is the Cytomegalovirus (CMV). Describe the involvement of microcephalic patients affected by the congenital infection by the Zika Virus or CMV. Data has been collected from microcephalic patients whose birth took place after 2016 and which also had the congenital infection confirmed or presumed. The researched data consists in: congenital infection, head circumference from birth, presence of epilepsy, treatment by mono or polytherapy, electroencephalographic patterns, neurological physical examination and evaluation of gross motor development. 21 microcephalic children have been included showing the following congenital infectious syndromes: 9 were affected by cytomegalovirus (43%), 6 by the Zika virus (29%) and 6 ones by presumed infection due to the Zika virus (29%). From those ones, 13 (62%) presented epilepsy diagnosis including generalized crises and 9 (69%) were in current use of polytherapy. All of them also showed disorganized and asymmetrical base rhythms. Concerning the epileptiform activity, 5 presented multifocal activity and 3 ones hypsarrhythmia. All of the patients went under neuroimaging: 12 (57%) of them presented calcifications and 5 (24%) hydrocephalus. On the neurological exam, 17% presented a decreased axial tone and an enlarged appendicular. Smaller head circumference children had greater motor impairment and severity in the epilepsy. There was no difference in the frequency of epilepsy between children with CSZ and CMV. Epilepsy is confirmed as one of the most important complications of congenital infections by CSZ and CMV. •The congenital infections are implicated in the development of epilepsy, changing in the neurologic physical exam and in motor development.•The microcephaly outbreak highlighted the importance of studies which could establish the relation between the microcephaly and cerebral involvement.•There have not been identified a significant difference when comparing the manifestations in neither the epilepsy profile nor in the electroencephalographic characteristics in patients with CSZ and CMV, probably due to the fact that both the pathogens are causative of microcephaly.