Do Children With Congenital Zika Syndrome Have Cerebral Palsy?

INTRODUCTION

According to the Definition and Classification of Cerebral Palsy, April 2006, cerebral palsy (CP) refers to¹:

a group of permanent disorders of movement and posture, causing activity limitation, that are attributed to non-progressive disturbances that occurred in the developing fetal or infant brain. In addition to the motor symptoms, disturbances of sensation, perception, cognition, communication, behaviour, epilepsy, and secondary musculoskeletal abnormalities may also be present.

Intrauterine infections, including congenital infections, are reported to be the identified etiology in 5%–10% of cases of CP, with congenital cytomegalovirus being the most common viral infection related to this diagnosis.²

In 2015, an outbreak of the Zika virus was reported in Brazil, followed by a significant increase in the prevalence of congenital microcephaly and neurological abnormalities in children born to mothers infected with the Zika virus during pregnancy.³ The causal link between those events was confirmed, and vertical transmission of the virus was established for the first time.^4,5 The affected children were soon described as having congenital Zika syndrome (CZS). The classic phenotype comprised severe microcephaly and partly collapsed skull, typical neuroimaging features (cerebral atrophy and subcortical calcifications), ocular abnormalities (macular scarring and focal pigmentary retinal mottling), arthrogryposis, and early severe hypertonia.⁶ This classic clinical picture was reported to be present in 5%–14% of the infected newborns.⁷ A thorough analysis of the literature showed that the clinical and neuroradiological features could be present in a spectrum of severity, even though the majority of the …