Investigation of Sleep Patterns and Electroencephalographic Characteristics in Children With Microcephaly Associated With Congenital Zika Syndrome and Severe Cerebral Palsy.

This study investigates the sleep characteristics and electroencephalographic (EEG) activity in 65 children with microcephaly associated with congenital Zika syndrome (CZS) and severe cerebral palsy. The children, born between 2015 and 2017, tested positive for Zika and exhibited neuroimaging findings consistent with CZS. Extended neurological polysomnography was conducted following American Academy of Sleep Medicine guidelines. Sleep was classified into quiet (N), active (R), and indeterminate (I) phases, with frequent epileptiform activity observed. Epileptiform activity was prevalent during wakefulness, N sleep, and R sleep. Seizures occurred in 29.2% of the children during polysomnography. Key sleep waves like sleep spindles, k-complexes, and delta waves were rarely identified. During wakefulness, a continuous EEG trace was seen in 49.2% of the children, whereas burst-suppression (BS) was noted in 47.7%. The absence of posterior dominant rhythm and the presence of sharp slow wave activity were common. In N sleep, most children exhibited BS activity (63.1%) and sharp slow wave activity (95.3%), with 98.5% showing epileptiform activity. There was little difference in EEG traces between wakefulness and N sleep in over half of the children. In R sleep, continuous EEG trace and rapid eye movement were noted in 53.8% and 69.2% of the children, respectively, with 93.8% showing epileptiform activity. The study suggests that brainstem and cortical lesions may explain these findings, highlighting the complex neurological and sleep patterns in children with CZS and the need for further research.