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Motor and cognitive response to intensive multidisciplinary therapy: the first reported case of congenital Zika virus
Gabriela Gama1,2, Maria da Conceição Matias1, Mell de Luiz Vânia1
1Instituto de Pesquisa Professor Joaquim Amorim Neto (IPESQ), Paraíba, Brazil.
Insights
This study details the first reported case of congenital Zika syndrome (CZS) in a child followed for four years. Despite severe impairment, the child showed significant motor and cognitive improvements.
Area of Science:
- Neurology
- Pediatrics
- Infectious Diseases
Background:
- Congenital Zika syndrome (CZS) is a severe condition resulting from prenatal Zika virus infection.
- Understanding the long-term developmental trajectory of CZS is crucial for clinical management and parental support.
Observation:
- A case of CZS was monitored from pregnancy to four years of age.
- Key developmental milestones, including head circumference, weight, height, and motor function (Gross Motor Function Measure - GMFM), were assessed periodically.
- The child experienced hospitalizations but no convulsive seizures during the follow-up period.
Findings:
- The child presented with microcephaly at birth (head circumference z-score = -3.15), which persisted (z-score = -4.48 at 48 months).
- Despite neurological impairment, the child achieved unsupported standing at 17 months and independent walking at 36 months.
- Motor function scores (GMFM-88 and GMFM-66) showed progressive improvement over the four years.
Implications:
- This case highlights the potential for significant motor and cognitive development in children with CZS, even with severe initial impairment.
- Early and consistent therapeutic interventions, such as physiotherapy, are vital for optimizing developmental outcomes in CZS.
- Further research is needed to understand the variability in CZS presentation and long-term prognosis.
Purpose:
To provide a detailed description of the development of the first case of congenital Zika syndrome (CZS) to be reported in the literature worldwide.
Case Description:
This report describes the case of a child with CZS monitored from pregnancy until four years of age, with periodic evaluations of head circumference, weight, height, motor function according to the Gross Motor Function Measure (GMFM-88), and the occurrence of comorbidities.
Outcomes:
The child's birth weight and length were normal (z-score = 1.1 and -1.95, respectively), while head circumference was below the expected value (z-score = -3.15). At 48 months, head circumference reached 43 cm (z-score = -4.48). During daily home physiotherapy sessions, the child achieved developmental milestones, standing unsupported at 17 months, with a GMFM-88x score of 137. With specialist therapy, the child walked independently at 36 months and a total GMFM-66 score of 214 was achieved by 42 months. In the four years of follow-up, the child was hospitalized four times for different reasons. No convulsive seizures occurred.
Conclusions:
Despite severe neurological impairment, the child's weight and height are adequate for age, with motor and cognitive function improving over the first four years of life.
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