Polymicrogyria in infants with symptomatic congenital cytomegalovirus at birth is associated with epilepsy: A retrospective, descriptive cohort study

Abstract

Aim: To identify neonatal magnetic resonance imaging (MRI) features that predict the likelihood of children with congenital cytomegalovirus (cCMV) developing epilepsy, together with clinical features and a validated MRI scoring system.

Method: This was a retrospective descriptive cohort study of infants with cCMV referred to a paediatric infectious disease centre between April 2012 and March 2022, and followed up for at least 2 years. MRI was performed before 4 months of age and assessed by two paediatric neuroradiologists.

Results: Ninety children with cCMV were included, 46 were female and 44 were male. The median age at MRI was 20 days, (standard deviation = 34, range = 1-200). Seventy-two of 90 children were symptomatic at birth and 7 of 72 developed epilepsy (9.7% of symptomatic infants, 7.8% of total). None of 18 asymptomatic children developed epilepsy. Those with epilepsy were more likely to be symptomatic at birth (100% vs. 76%, p = 0.14) and to have cortical malformations (86% vs. 15%, p < 0.001). Infants with polymicrogyria (PMG) were more likely to develop epilepsy (odds ratio = 35 [3.9-317.1], p < 0.001). A 1-year remission was achieved in three of seven children; four required multiple antiseizure medications without remission.

Interpretation: The strongest correlate of epilepsy development was PMG. Infants with symptomatic cCMV at birth and PMG were more likely to develop epilepsy, and were likely to require one or more antiseizure medications. Parents of infants with cCMV and cortical malformations should be counselled regarding this risk. Including PMG severity in cCMV MRI scoring could improve epilepsy risk prediction.

FIGURE 1

Axial non‐contrast T2‐weighted fast spin echo sequences demonstrating imaging features in a subset of children who developed epilepsy (a,b) and those who did not (c‐e). (a) Two‐month‐old female, born at 30 weeks + 6 days, with diffuse bilateral polymicrogyria (PMG), bilateral caudothalamic groove cysts, bilateral white matter signal abnormality, and parenchymal calcifications in the posterior white matter. She developed epilepsy. (b) One‐day‐old male, born at 38 weeks + 5 days, with diffuse bilateral PMG, bilateral white matter signal abnormality and periventricular parenchymal calcifications in the posterior white matter. He developed epilepsy. (c) Two‐day‐old female, born at 36 weeks + 0 days, with diffuse bilateral PMG, left greater than right, sparing the posterior parietal lobe on the right. She did not develop epilepsy. (d) Twenty‐day‐old male, born at 36 weeks + 5 days, with bilateral perisylvian PMG (white arrows) and patchy white matter signal abnormality. He did not develop epilepsy. (e) Seventeen‐day‐old male, born at 37 weeks + 2 days, with bilateral perisylvian PMG. He did not develop epilepsy.