Congenital infection can cause epilepsy when infection during fetal development injures the developing brain or disrupts cortical formation.
The older acronym “TORCH” remains familiar, but it no longer covers the full range of recognised congenital pathogens.
Which infections are relevant?
Important congenital and perinatal pathogens include cytomegalovirus (CMV), toxoplasma, rubella, herpes simplex virus, syphilis, varicella-zoster virus, Zika virus, HIV and others.
Congenital CMV
Congenital CMV is one of the most important infectious causes of neurodevelopmental disability and non-genetic sensorineural hearing loss worldwide.
Brain abnormalities can include polymicrogyria, white-matter injury, calcification, ventriculomegaly and abnormal cortical development.
CMV and epilepsy
Epilepsy risk is particularly high when congenital CMV causes cortical malformations.
A 2025 cohort found polymicrogyria was strongly associated with later epilepsy among infants who had symptomatic congenital CMV at birth.
Toxoplasmosis
Congenital toxoplasmosis can produce intracranial calcifications, hydrocephalus and chorioretinitis.
Structural brain injury can later support focal or generalised seizures.
Zika virus
Congenital Zika syndrome can cause severe cortical maldevelopment, calcification, microcephaly and epilepsy.
The neurological phenotype is broad and reflects disruption of fetal brain development rather than a single epilepsy syndrome.
Rubella
Congenital rubella syndrome can involve hearing loss, cardiac disease, eye abnormalities and neurodevelopmental impairment.
Epilepsy can occur when the CNS is affected, although vaccination has greatly reduced congenital rubella in countries with high vaccine coverage.
Herpes simplex
Neonatal herpes can cause encephalitis and destructive brain injury.
Survivors of CNS disease have an increased risk of later epilepsy and developmental impairment.
Acute neonatal seizures versus later epilepsy
Seizures during the active congenital or neonatal infection are acute symptomatic seizures.
Later recurrent unprovoked seizures represent epilepsy caused by the residual brain injury.
MRI
Neuroimaging can help define the type and extent of fetal brain injury.
A 2024 systematic review of congenital CMV emphasised the prognostic value of MRI for CNS involvement and long-term neurological outcome.
Hearing and vision
Congenital infections can affect hearing and vision as well as seizure risk.
Follow-up therefore often requires audiology, ophthalmology, developmental assessment and neurology rather than epilepsy care alone.
Genetic mimics
Some genetic disorders produce calcification, microcephaly or cortical malformations that can resemble congenital infection.
Modern diagnosis may therefore combine infectious testing with genomic investigation.
Prevention
Prevention depends on the pathogen and may include vaccination, antenatal screening, hygiene measures, maternal treatment, prevention of HIV transmission and mosquito control.
The central point
Congenital infection can create epilepsy by altering the developing brain before or around birth. The epilepsy is a consequence of neurological injury or malformation—not persistent contagious epilepsy.
Related reading
Polymicrogyria and Epilepsy →
Infectious Epilepsies →
Sources
- Clinical review of congenital and perinatal infections — 2026
- Congenital CMV and CNS involvement — 2025 review
- MRI in congenital CMV — 2024 systematic review
- Polymicrogyria and epilepsy in symptomatic congenital CMV — 2025
Evidence checked: September 2026.