Continuous epileptiform discharges during sleep as an evolutionary pattern in patients with congenital Zika virus syndrome

Epilepsia. 2020 Sep;61(9):e107-e115. doi: 10.1111/epi.16631. Epub 2020 Aug 21.

Abstract

Congenital Zika virus syndrome (CZVS) is associated with severe neurological deficits. Clinical characteristics of epilepsy and the electroencephalographic (EEG) pattern in CZVS were documented in infancy. In this study, we aimed to describe the EEG findings observed during the follow-up of children with CZVS. Seventy-six EEGs of 55 children (60% female; mean age = 50 months) with confirmed CZVS were analyzed, considering the background, interictal, and ictal epileptiform discharges. Continuous (or almost continuous) epileptiform discharges during non-rapid eye movement sleep were identified in 22 (40%) patients. In 20 (90.1%) patients, the pattern was symmetrical, with an anterior predominance of the epileptiform activity. All patients with this pattern had epilepsy, which was severe in 15 (68.2%) and demanded polytherapy in 19 (86.4%). Subcortical calcifications (77.3%) and multifocal EEGs (72.8%) in earlier ages occurred more often in patients with this pattern. Other unspecific interictal EEG patterns were focal epileptiform discharges in 23 (41.8%) and multifocal activity in six (10.9%). In CZVS, continuous (or almost continuous) epileptiform discharges during sleep emerge as a pattern after the second year of life. This was associated with severe and drug-resistant epilepsy, but not necessarily with an apparent regression. Subcortical calcifications and multifocal epileptiform discharges in infancy are associated with this pattern.

Keywords: EEG; congenital Zika syndrome; epilepsy; neuroimaging.

MeSH terms

  • Anticonvulsants / therapeutic use
  • Basal Ganglia Diseases / diagnostic imaging
  • Basal Ganglia Diseases / physiopathology
  • Brain / diagnostic imaging
  • Brain / physiopathology*
  • Brain Stem / diagnostic imaging
  • Brain Stem / pathology
  • Calcinosis / diagnostic imaging
  • Calcinosis / physiopathology
  • Cerebellum / diagnostic imaging
  • Cerebellum / pathology
  • Child, Preschool
  • Disease Progression
  • Drug Resistant Epilepsy / diagnostic imaging
  • Drug Resistant Epilepsy / drug therapy
  • Drug Resistant Epilepsy / physiopathology
  • Electroencephalography
  • Epilepsies, Partial / diagnostic imaging
  • Epilepsies, Partial / drug therapy
  • Epilepsies, Partial / physiopathology
  • Epilepsy / diagnostic imaging
  • Epilepsy / drug therapy
  • Epilepsy / physiopathology*
  • Female
  • Humans
  • Male
  • Malformations of Cortical Development / diagnostic imaging
  • Malformations of Cortical Development / physiopathology*
  • Organ Size
  • Polymicrogyria / diagnostic imaging
  • Polymicrogyria / physiopathology
  • Severity of Illness Index
  • Sleep*
  • Syndrome
  • Thalamic Diseases / diagnostic imaging
  • Thalamic Diseases / physiopathology
  • Zika Virus Infection / congenital*
  • Zika Virus Infection / diagnostic imaging
  • Zika Virus Infection / physiopathology*

Substances

  • Anticonvulsants