Síndrome da zika congênita: características demográficas, clínicas e tomográficas associadas à microcefalia ao nascer e à epilepsia refratária

Abstract

The present study aimed to analyze demographic, clinical and cranial tomography characteristics associated with microcephaly at birth and refractory epilepsy in children with Congenital Zika Syndrome up to 36 months of age. This is a prospective cohort study of 110 children with Congenital Zika Syndrome born in maternities in the state of Maranhão, Brazil, from March 2015 to September 2018, followed up to 36 months of age in a health center reference in neurodevelopment, assistance and rehabilitation of children (NINAR). Head circumference Z scores at birth decreased more than doubled by six months of age for children with microcephaly (-3.77 to -6.39) and normocephaly (-1.03 to -3.84). At six months of age, the mean head circumference Z scores of children born without microcephaly (n=32) were nearly equal to those of children born with microcephaly (n=61). Clinical, neurological data, changes in cranial tomography, ophthalmological changes and motor function were worse in children born with microcephaly. Of the 100 (91.7%) children who had epilepsy up to 36 months of life, 68 (68%) were refractory. The types of epileptic seizures that were associated with refractory epilepsy were focal ocular seizures, generalized tonic and tonic-clonic seizures. There was also an association with microcephaly at birth, severe microcephaly, excess of nuchal skin, ventriculomegaly, reduced brain parenchyma volume and hypoplasia or malformation of the cerebellum. Sleep disturbance, irritability, continuous crying, dysphagia and gross motor function were clinical signs associated with refractory epilepsy, as well as the presence of ocular changes, head circumference in the first year of life and weight in the first six months. Children born without microcephaly were slightly less likely to have severe neurological impairment and to develop postnatal-onset microcephaly, and some original differences between the groups with and without microcephaly tend to dissipate with age. Refractory epilepsy in congenital Zika syndrome was associated with the degree of neurological damage in the child, with emphasis on the reduction in the volume of the brain parenchyma and damage to the cerebellum.