Clinical and neurodevelopmental features in children with cerebral palsy and probable congenital Zika

Brain Dev. 2019 Aug;41(7):587-594. doi: 10.1016/j.braindev.2019.03.005. Epub 2019 Mar 23.


Objective: To describe the neurological and neurodevelopmental features at 1 year of age in children with cerebral palsy (CP) related to probable congenital Zika (CZ), followed in a referral neurorehabilitation hospital.

Methods: Data on 82 children with CP associated with probable CZ, who consecutively attended the neurodevelopmental and neurological assessment around one year of age, were collected. For neurodevelopmental evaluation, Bayley-III Scales of Infant and Toddler Development was used. Descriptive statistical analysis was performed.

Results: The children were admitted into the rehabilitation program at a young age (mean age: 4.8 months, SD 3.1), followed beyond the first year of life (mean age of follow up: 13.2 months, SD 2.1), born to young mothers (mean age: 28.1 years, SD 5.9), in their first pregnancy (62.2%). The majority had severe congenital microcephaly (62.0%), spastic CP (96.3%), epilepsy (63.4%), absent expected postural reactions (93.2%), abnormal persistence of primitive reflexes (94.7%), and severe neuroimaging abnormalities, predominantly calcifications (97.6%). Extremely low performances on cognitive (95.1%), language (97.6%) and motor (97.6%) developmental composite scores were observed. There was a correlation between the cognitive score with the birth head circumference (HC) (r = 0.3, p = 0.01) and with the follow up HC (r = 0.4, p < 0.01), as well as between the follow up HC with the motor score (r = 0.2, p = 0.03).

Conclusion: Congenital Zika may be associated with a severe form of CP, mainly bilateral spastic, with a severe global neurodevelopmental impairment and early signs of a poor prognosis for independent walking. Head circumference may be a prognostic marker among those children. These results may help establish goals for the rehabilitation program and identify priority health services.

Keywords: Cerebral palsy; Neurodevelopment; Zika virus.

MeSH terms

  • Cerebral Palsy / complications
  • Cerebral Palsy / diagnostic imaging
  • Cerebral Palsy / physiopathology*
  • Cerebral Palsy / virology*
  • Developmental Disabilities / diagnosis
  • Developmental Disabilities / diagnostic imaging
  • Developmental Disabilities / virology
  • Female
  • Gestational Age
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Microcephaly / complications
  • Microcephaly / diagnostic imaging
  • Microcephaly / virology
  • Neurodevelopmental Disorders / diagnosis
  • Neurodevelopmental Disorders / diagnostic imaging
  • Neurodevelopmental Disorders / physiopathology
  • Neurodevelopmental Disorders / virology
  • Neuroimaging / methods
  • Neurologic Examination / methods
  • Zika Virus / isolation & purification*
  • Zika Virus Infection / diagnostic imaging
  • Zika Virus Infection / physiopathology*
  • Zika Virus Infection / virology