Zika infection and epilepsy: A discussion with Dr. Eli Mizrahi

Seizures and epilepsy are commonly reported in infants born with probable congenital Zika virus infection, according to a commentary published online in JAMA Neurology and written by medical officials at the Centers for Disease Control and Prevention (CDC). In one study described in the article, 50% of infants born in Brazil with probable congenital Zika virus syndrome had clinical seizures.

In this interview, Eli M. Mizrahi, MD, President of the American Epilepsy Society, discusses the relationship between Zika virus and epilepsy. He also offers advice to help families and caregivers recognize and report seizure symptoms in infants and children.

MDLinx: How is Zika infection believed to cause or activate epilepsy?

Dr. Mizrahi: Zika virus adversely impacts early neuronal cell growth and differentiation first by direct infection and then through cell death and limited neurogenesis. The well-known manifestation of Zika virus infection of the central nervous system is severe microcephaly, which is caused by lack of subcortical and cortical development. Other, less well-known manifestations of brain dysfunction include the occurrence of seizures and epilepsy.

There has been much emphasis on the most dramatic result of Zika virus infection – severe microcephaly. However, there is still much to learn about the manifestations of less obvious results of infection.

MDLinx: The CDC currently recommends that newborns suspected of possible congenital Zika infection should receive a comprehensive physical exam, head ultrasound, standard newborn hearing assessment, and Zika virus laboratory testing. Would any of these tests uncover epilepsy?

Dr. Mizrahi: The detailed medical history, which the health care provider obtains as part of the comprehensive physical examination, should help in providing suggestions that the infant may have experienced seizures. Questions about the occurrence of sudden and sustained movements, changes in attention or behavior, and changes in respirations or heart rate may prompt the health care provider to consider whether the infant has seizures or epilepsy, if the seizures are recurrent. If the history does suggest seizure occurrence, an electroencephalogram (EEG) may be helpful in further characterizing the problem.

MDLinx: What, if anything, can neurologists do to improve awareness of epilepsy or seizures among pediatricians, family doctors, caregivers, and parents?

Dr. Mizrahi: Neurologists can reinforce the idea that infants with Zika virus-related signs and symptoms may be at risk to develop seizures and epilepsy. Pediatricians, family and community medicine physicians, and health care providers should include in discussions with families of Zika virus-affected infants ways to recognize seizures in their children. However, it should be emphasized that the long-term outcome for these infants will be determined by the degree to which the central nervous system has been impacted by the Zika virus, rather than the seizures, if they occur, alone.

Finally, all health care providers should emphasize that prevention of Zika virus infection remains our most effective approach to this disorder through protection from mosquito bites, careful planning of travel, and understanding that Zika virus can be transmitted through sexual contact.

About Dr. Mizrahi: In addition to his role as the American Epilepsy Society President, Dr. Mizrahi is Professor of Neurology and Pediatrics and the James A. Quigley Endowed Chair in Pediatric Neurology at Baylor College of Medicine, in Houston, TX.