# Clinical, Neuroimaging and Video Electroencephalography Findings in Children With Congenital Zika Syndrome: An Analysis From a Neurorehabilitation Centre

## TL;DR

This study examines the neurological and clinical features of children with congenital Zika syndrome, highlighting severe brain abnormalities and the need for long-term care.

## Contribution

The study provides a comprehensive characterization of CZS through integrated clinical, neuroimaging, and EEG findings in a specialized rehabilitation setting.

## Key findings

- Children with CZS show high rates of bladder/bowel incontinence, epilepsy, and facial abnormalities.
- Brain imaging reveals reduced brain volume, abnormal corpus callosum, and intracranial calcifications.
- Significant links exist between musculoskeletal malformations and brain abnormalities like enlarged ventricles.

## Abstract

Congenital Zika syndrome (CZS) represents a spectrum of fetal and neonatal abnormalities resulting from in utero Zika virus (ZIKV) transmission during pregnancy. Given the severe multisystem disabilities, relative recency of the epidemic and limited long‐term data, comprehensive characterization at specialized centres is crucial.

This study aimed to examine clinical symptoms, brain imaging and brain activity (video electroencephalography, VEEG) patterns in children with CZS receiving care at a specialized rehabilitation centre.

We conducted a cross‐sectional study from August 2018 to January 2019 with 48 children diagnosed with CZS according to the Brazilian Ministry of Health criteria. We collected clinical data from electronic medical records.

The most common clinical problems included bladder and bowel incontinence (97.9%), epilepsy (85.5%), facial abnormalities (89%), swallowing difficulties (83.3%), excessive irritability (81.3%), eye misalignment (75%), sleep problems (72.9%), acid reflux (62.0%) and vision problems (62.5%). Brain imaging revealed reduced brain tissue volume (95.8%), abnormal corpus callosum (91.1%), enlarged fluid‐filled spaces in the brain (89.5%), calcium deposits at the brain's outer layers (78.3%) and abnormally thick brain folds (71.1%). We found significant links between bone/muscle malformations and both white matter disease (p = 0.036) and enlarged brain ventricles (p = 0.031).

Children with CZS consistently show motor difficulties, multiple clinical problems and characteristic brain abnormalities. These findings predict significant limitations in daily activities, movement and cognitive–social development.

Children with congenital Zika syndrome followed at a neurorehabilitation centre demonstrated severe neurological impairment characterized by microcephaly, cortical malformations, intracranial calcifications and multifocal epileptiform activity. Integrated clinical, neuroimaging and video‐electroencephalographic (EEG) findings highlight the extensive neurodevelopmental impact and need for long‐term multidisciplinary care.