Maternal infections during pregnancy are known to affect the embryo and cause brain damage resulting in various malformations according to the critical timing of organogenesis.29 Toxoplasmosis, syphilis, rubella, herpes, cytomegalovirus (CMV), and other viruses are known to affect central nervous system prenatally.
Newly acquired toxoplasmosis occurs in about 0.1~2% of all pregnancies30 and mental retardation and epilepsy (80%) were frequently reported in cases with congenital toxoplasmosis.23,29,30 This etiology accounted for 6.8% of putative risk factor for epilepsy in inmates of an institute for the mentally handicapped.27 Acute and remote symptomatic seizures can be associated with congenital toxoplasmosis in up to 50% of affected children, who are often associated with chorioretinitis and a variety of CNS abnormalities including microcephaly, hydrocephalus, cerebral calcification, cerebral palsy and blindness.23,29,30
Congenital rubella occurs in more than 80% of infants of maternal rubella during the first 12 weeks of pregnancy, in 54% during 13 to 14 weeks, and in 25% at the end of the second trimester.31 The infection rate increases again during the last month of pregnancy. Histologically three types of neuronal damage have been identified: cellular growth retardation or inhibition, cellular necrosis related to vascular lesions and inflammation.32 Seizures occur in 25% of the affected children.33 West syndrome and Lennox-Gastaut syndrome (LGS) may be the presenting epileptic syndrome. Another type of seizures are abrupt vasomotor changes.33 About one-third of affected children demonstrate a variety of EEG abnormalities, including hypsarrhythmia.
Prenatal cytomegalovirus (CMV) infection occurs through the first to third trimesters in symptomatic patients. CMV has an affinity for the rapidly proliferating subependymal cells lining the ventricles. Viral multiplication and subsequent calcium deposition result in brain disruption or dysgenesis with periventricular or diffuse calcification. Microcephaly (50%), hydrocephalus, neuronal migration disorders, porencephaly, and polycystic encephalomalasia are observed. Mental retardation, visual disturbance, hearing loss, language disorders, and epilepsy can be observed.23,29,30
Varicella embryopathy occurs in approximately 2% of infants born to mothers infected with varicella during the first 20 weeks of gestation34 and is associated with microcephaly, porencephaly, and cerebral calcification and subsequent mental retardation and seizures (26~50%).29
Transplacental infection of herpes simplex type 2 has been recognized in the primary maternal infection during pregnancy, resulting in microcephaly, intracranial calcifications, epilepsy, microphthalmos and retinal dysplasia.29,30
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