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Brain Dev. 2019 Aug;41(7):587-594. doi: 10.1016/j.braindev.2019.03.005. Epub 2019 Mar 23.

Clinical and neurodevelopmental features in children with cerebral palsy and probable congenital Zika.

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SARAH Network of Rehabilitation Hospital, Salvador, Bahia, Brazil. Electronic address:
Federal University of Bahia, Salvador, Bahia, Brazil.
Boston Children's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Massachusetts General Hospital, Boston, MA, USA.
SARAH Network of Rehabilitation Hospital, Salvador, Bahia, Brazil.
Bahiana School of Medicine and Public Health, Salvador, Bahia, Brazil.



To describe the neurological and neurodevelopmental features at 1 year of age in children with cerebral palsy (CP) related to probable congenital Zika (CZ), followed in a referral neurorehabilitation hospital.


Data on 82 children with CP associated with probable CZ, who consecutively attended the neurodevelopmental and neurological assessment around one year of age, were collected. For neurodevelopmental evaluation, Bayley-III Scales of Infant and Toddler Development was used. Descriptive statistical analysis was performed.


The children were admitted into the rehabilitation program at a young age (mean age: 4.8 months, SD 3.1), followed beyond the first year of life (mean age of follow up: 13.2 months, SD 2.1), born to young mothers (mean age: 28.1 years, SD 5.9), in their first pregnancy (62.2%). The majority had severe congenital microcephaly (62.0%), spastic CP (96.3%), epilepsy (63.4%), absent expected postural reactions (93.2%), abnormal persistence of primitive reflexes (94.7%), and severe neuroimaging abnormalities, predominantly calcifications (97.6%). Extremely low performances on cognitive (95.1%), language (97.6%) and motor (97.6%) developmental composite scores were observed. There was a correlation between the cognitive score with the birth head circumference (HC) (r = 0.3, p = 0.01) and with the follow up HC (r = 0.4, p < 0.01), as well as between the follow up HC with the motor score (r = 0.2, p = 0.03).


Congenital Zika may be associated with a severe form of CP, mainly bilateral spastic, with a severe global neurodevelopmental impairment and early signs of a poor prognosis for independent walking. Head circumference may be a prognostic marker among those children. These results may help establish goals for the rehabilitation program and identify priority health services.


Cerebral palsy; Neurodevelopment; Zika virus

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