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Sleep EEG patterns in infants with congenital Zika virus syndrome
Maria Durce Costa Gomes Carvalho1, Demócrito de Barros Miranda-Filho1, Vanessa van der Linden2
1UPE (University of Pernambuco), Recife, Brazil.
Insights
Sleep EEGs in infants with congenital Zika virus syndrome show frequent abnormalities, including hypsarrhythmia and epileptogenic activity, even before epilepsy develops.
Area of Science:
- Neurology
- Pediatrics
- Infectious Diseases
Background:
- Congenital Zika virus (ZikV) syndrome is a significant cause of microcephaly in neonates.
- Understanding the neurological manifestations, particularly electroencephalogram (EEG) patterns, is crucial for diagnosis and management.
Purpose of the Study:
- To characterize the sleep EEG patterns in neonates and infants diagnosed with microcephaly secondary to congenital Zika virus syndrome.
- To identify specific EEG abnormalities associated with this condition.
Main Methods:
- A descriptive case series analyzing 37 sleep EEGs from infants with microcephaly.
- Infants were evaluated between October 2015 and February 2016 in Northeast Brazil.
- Standardized protocols included EEG, neuroimaging, and ZikV detection (PCR and antibodies).
Main Results:
- The majority of EEGs (62%) exhibited interictal abnormalities, including focal spikes and sharp waves.
- Common background abnormalities included diffuse low voltage, asymmetry, and modified hypsarrhythmia.
- Electrographic seizures, without clinical signs, were observed in 4 infants.
Conclusions:
- Sleep EEG findings in congenital Zika virus syndrome are consistently abnormal.
- Hypsarrhythmia and interictal epileptogenic activity are predominant EEG abnormalities.
- These abnormalities are present even in infants who have not yet developed clinical epilepsy.
Objectives:
To describe sleep EEG patterns of neonates, and infants with microcephaly due to congenital Zika virus (ZikV) syndrome.
Methods:
A descriptive case series of EEGs performed in a cohort of neonates with microcephaly monitored from October 2015 to February 2016 at a University Hospital in Northeast Brazil. Infants were investigated following an established protocol that includes EEG, neuroimaging studies, PCR and specific antibodies for ZikV detection.
Results:
EEGs (n=37) from 37 infants were reviewed. Age at investigation varied from 1 to 5months (mean=2.6). Diffuse low voltage (n=7), background asymmetry (n=6) and modified hypsarrhythmia with or without burst-suppression (n=11), were the main background abnormalities identified. Interictal EEG abnormalities were identified in 23 recordings (62%) and localized as focal frontal (n=8) or occipital (n=2) spikes/sharp, multifocal spikes/sharp waves (n=13). Electrographic seizures without clinical manifestation were identified in 4 recordings and characterized as focal pseudo rhythmic pattern. Further findings were focal high amplitude slow waves that were registered in the frontal (n=3) or occipital (n=1) regions.
Conclusions:
Different types of EEG abnormalities were encountered with a predominance of interictal epileptogenic activity and hypsarrhythmia.
Significance:
Sleep EEGs in congenital Zika virus syndrome are consistently abnormal even in infants who have not yet developed epilepsy.
