MOTOR PROGNOSIS AMONG ACQUIRED VERSUS CONGENITAL MICROCEPHALIC CHILDREN WITH CONGENITAL ZIKA SYNDROME

E.H.M. Takahasi^1,2, M.T.S.S.d.B. Alves¹, M.R.C. Ribeiro¹, V.F.P. Souza¹, V.M.F. Simões¹, P.d.S. Sousa³, A.A.M. Silva¹

Background: Microcephaly at birth was the first finding associated with congenital Zika virus (ZIKV) infection. However, it was observed that even children born with normocephaly can develop postnatal microcephaly. In addition, there is little information about the relationship between congenital and acquired microcephaly and the severity of the motor condition presented by children with congenital Zika syndrome (CZS).

Purpose: To evaluate the association between congenital and acquired microcephaly and motor severity in children with CZS.

Methods: One hundred children with CZS and cerebral palsy (59 male; mean age: 28,0 months; SD 3,1)  were evaluated with the Gross Motor Function Classification System (GMFCS). Children classified as GMFCS I to III were considered to present mild to moderate cerebral palsy and those classified as GMFCS IV to V were considered to present severe cerebral palsy. Head circumference (hc) at birth and at two years of age (between 22 to 26 months) were collected and transformed into z-scores. Children were classified as having normocephaly when hc z-score at birth and at two years of age were >= -2; congenital microcephaly when hc z-score at birth and at two years of age were <-2 and acquired microcephaly when hc z-score at birth was >=2  and hc z-score at two years of age was <-2. None of the children who had microcephaly at birth became nomocephalic at 2 years of age. Chi-square test was performed to compare the groups.

Results: Five children (5%) were classified as mild to moderate cerebral palsy (3 GMFCS level I and 2 GMFCS level III) and 95 (95%) as severe cerebral palsy (6 GMFCS level IV and 89 GMFCS level V). Three children (3%) were normocephalic, 53 (53%) presented congenital microcephaly and 22 (22%) presented  acquired microcephaly. No significant association (p=0,07) was observed between the cerebral palsy severity and the presence of microcephaly.

Conclusion(s): At two years of age, most children born with normocephaly developed acquired microcephaly, and the prognosis of these children to develop severe cerebral palsy does not differ from those with congenital microcephaly.

Implications: Even children born without microcephaly must be closely monitored by rehabilitation teams, as they also have reserved motor prognosis and require early stimulation programs to maximize motor potential.

Funding, acknowledgements: CNPq (Grant number 440573/2016-5), FAPEMA PPSUS (grant number 008/2016), DECIT and CAPES (grant number 88881.130813/2016-01)

Keywords: Zika virus, Microcephaly, Motor activity

Topic: Paediatrics: cerebral palsy

Did this work require ethics approval? Yes

Institution: Federal University of Maranhao

Committee: Ethics and Research Committee

Ethics number: 2111125