Neural behavior during cystometry of children with congenital Zika virus: Pilot study

Understanding the neural control of bladder function is essential for advancing neuroscience and improving urological outcomes, especially in children with neurological impairments such as Congenital Zika Syndrome (CZS). Recent evidence of urological dysfunctions in CZS patients highlights the need for integrated neurological and urodynamic investigations. Thus, this exploratory pilot study aimed to evaluate the feasibility and safety of simultaneous electroencephalography (EEG) and urodynamic studies in children with CZS, and to characterize the patterns of bladder and brain activity.

This is an exploratory pilot study of a series of ten children with confirmed CZS admitted at a pediatric urology service in the city of Macaíba/RN. This study was approved by the Research Ethics Committee of the Federal University of Rio Grande do Norte (UFRN) under registration CAAE-17583419.7.0000.5537. Urological assessment was conducted through urodynamic studies in accordance with the standardized guidelines established by the International Children's Continence Society (ICCS).

Ten children were included in the study. In nine cases, neurogenic bladder was correlated with reduced cystometric capacity, highlighting a significant functional impairment. Concomitant EEG analysis during cystometry revealed contrasting patterns of neural activity depending on the bladder state. During episodes of detrusor overactivity, there was a marked increase in delta power (p = 0.04) and a reduction in theta power (p = 0.04). Conversely, during the bladder filling phase, the opposite pattern was observed, with increased activity in the alpha and theta power, while beta and delta power decreased.

Simultaneous EEG and urodynamic assessments were both feasible and safe in children with CZS. Distinct patterns of cortical activity were observed during bladder hyperactivity and relaxation, highlighting the dynamic interplay between brain signals and bladder function. These findings suggest that CZS may disrupt the integration of neurological and urological processes in affected children. Further studies with a larger sample size are required to confirm and clarify the neural mechanisms of bladder control in children with CZS.