Epilepsy after congenital zika virus infection: EEG and neuroimaging features

•Epilepsy after ZIKV infection starts early in life and tends to be refractory.•Although frequent, most seizures with non- motor expression remain underdiagnosed.•Video – EEG is an important tool in order to recognize those events.•EEG and clinical developmental outcomes correlate with degree of brain malformations. To describe epilepsy after congenital Zika virus infection (ZIKV) and its relationship with structural neuroimaging findings. This was a cross-sectional study in children (aged 13–42 months) who were born with microcephaly due to ZIKV infection between 2015–2017. Patients underwent a brain imaging scan (magnetic resonance) and a video-EEG study. Among the patients (n = 43), 55.8 % were male, 88.4 % were born at term, mean head circumference at the birth was 29.7 ± 1.8 cm, and 44.8 % were infected in the first trimester of pregnancy. Neuroimaging was moderately abnormal in 30.2 % and severely abnormal in 46.5 % of patients. Early seizures (