EEG findings in a Case of Congenital Zika Virus Syndrome (P4.076)

Objective: To describe EEG findings in a newborn with congenital Zika Virus (ZIKV) disease. Background: ZIKV is an intensely neurotropic virus that targets neural progenitor cells and can result in microcephaly and seizures. Design/Methods: Here we describe a term female infant born to a mother who had exposure to ZIKV during first trimester during travel to El Salvador. She was transferred from an outside hospital for seizures at birth. On physical exam, infant had severe microcephaly, congenital left knee dislocation and bilateral hearing loss. Her clinical seizures consisted of myoclonic jerks of trunk and jittery movements of bilateral upper extremities. A loading dose of Phenobarbital was given followed by maintenance. VEEG monitoring was started. She continued to have these clinical events even after Fosphenytoin and Levetiracetam were added to the regimen. Midazolam drip was started and EEG improved. Midazolam drip was gradually weaned off. She was discharged home on phenobarbital and lorazepam. Results: Initial VEEG revealed frequent (60–70% of the record), long runs of generalized periodic discharges (GPDs), sharp/spike waves seen at 1–2Hz without evolution, and no electrographic seizures. Follow-up EEGs showed excessive multifocal sharps and spikes throughout the record at times admixed with brief runs of rhythmical alpha in the right mid temporal area and bilateral high voltage bursts of spike, poly spike and slow waves giving appearance of burst -suppression pattern. There was poor electrographic correlation with apparent clinical seizures. CT head revealed diffuse parenchymal calcifications and ventriculomegaly. MRI brain showed findings consistent with congenital ZIKV syndrome. On Serologic testing IgM ELISA and Zika PRNT was positive. Conclusions: There is not enough literature regarding EEG findings in infants with congenital ZIKV infection. From our experience, EEG findings are non-specific and seizures in congenital ZIKV infection appear to be refractory requiring multiple anti-seizure medications without significant benefit. Disclosure: Dr. Kaur has nothing to disclose. Dr. Manganas has nothing to disclose.