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Polymicrogyria in infants with symptomatic congenital cytomegalovirus at birth is associated with epilepsy: A
George Lawson1,2, Alexander Sheeka3,4, Pritika Gaur3
1Department of Paediatric Infectious Diseases, Imperial College Healthcare NHS Trust, London, UK.
Insights
Congenital cytomegalovirus (cCMV) can lead to epilepsy in infants. Neonatal MRI features, particularly polymicrogyria, strongly predict epilepsy risk in children with cCMV.
Area of Science:
- Neurology
- Pediatrics
- Infectious Diseases
Background:
- Congenital cytomegalovirus (cCMV) is a common viral infection in newborns.
- Epilepsy is a significant neurological complication in infants with cCMV.
- Predicting epilepsy risk is crucial for early intervention and management.
Purpose of the Study:
- To identify neonatal magnetic resonance imaging (MRI) features predicting epilepsy in children with cCMV.
- To correlate clinical features and MRI findings with epilepsy development.
- To evaluate the utility of a validated MRI scoring system for epilepsy risk.
Main Methods:
- Retrospective descriptive cohort study of infants with cCMV.
- MRI performed before 4 months of age and assessed by two neuroradiologists.
- Follow-up for at least 2 years to monitor for epilepsy development.
Main Results:
- Ninety infants with cCMV were included; 7.8% developed epilepsy.
- Symptomatic infants at birth and cortical malformations were more common in those with epilepsy.
- Polymicrogyria (PMG) was the strongest predictor of epilepsy (OR=35, p<0.001).
Conclusions:
- Polymicrogyria is a key predictor of epilepsy in infants with cCMV.
- Symptomatic infants with PMG and cCMV are at higher risk for epilepsy.
- Counseling parents about epilepsy risk is recommended for infants with cCMV and cortical malformations.
Aim:
To identify neonatal magnetic resonance imaging (MRI) features that predict the likelihood of children with congenital cytomegalovirus (cCMV) developing epilepsy, together with clinical features and a validated MRI scoring system.
Method:
This was a retrospective descriptive cohort study of infants with cCMV referred to a paediatric infectious disease centre between April 2012 and March 2022, and followed up for at least 2 years. MRI was performed before 4 months of age and assessed by two paediatric neuroradiologists.
Results:
Ninety children with cCMV were included, 46 were female and 44 were male. The median age at MRI was 20 days, (standard deviation = 34, range = 1-200). Seventy-two of 90 children were symptomatic at birth and 7 of 72 developed epilepsy (9.7% of symptomatic infants, 7.8% of total). None of 18 asymptomatic children developed epilepsy. Those with epilepsy were more likely to be symptomatic at birth (100% vs. 76%, p = 0.14) and to have cortical malformations (86% vs. 15%, p < 0.001). Infants with polymicrogyria (PMG) were more likely to develop epilepsy (odds ratio = 35 [3.9-317.1], p < 0.001). A 1-year remission was achieved in three of seven children; four required multiple antiseizure medications without remission.
Interpretation:
The strongest correlate of epilepsy development was PMG. Infants with symptomatic cCMV at birth and PMG were more likely to develop epilepsy, and were likely to require one or more antiseizure medications. Parents of infants with cCMV and cortical malformations should be counselled regarding this risk. Including PMG severity in cCMV MRI scoring could improve epilepsy risk prediction.
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