by Dr. Juliette Dufour
For November 2021, we have selected: Stephen T J Ray et al, Neurological manifestations of SARS-CoV-2 infection in hospitalised children and adolescents in the UK: a prospective national cohort study. Lancet Child Adolescent Health, 2021. https://doi.org/10.1016/ S2352-4642(21)00193-0.
Only case series exist regarding the neurological and psychiatric complications of infection with SARS CoV 2 in children and adolescents. The aim of this study was to describe these manifestations and to determine the prevalence of neurological manifestations in hospitalised patients under 18 years-old.
Our authors of the month conducted a prospective national study in the UK using an online network of secure rapid-response notification portals (CoroNerve study group), in order to reflect the full spectrum of neurological complications of paediatric COVID-19 in the UK.
Patients were included if they were under 18 years old and had an history of laboratory confirmed SARS CoV-2 infection (positive PCR or/and serology) or had completed the Royal College of Paediatrics and Child Health criteria for PIMS-TS (Paediatric Inflammatory Multisystem Syndrome-Temporally associated with SarS CoV2) and presented neurological symptoms.
The authors identified 52 cases between April 2, 2020 and Feb 1 2021, which represent 3.8% of all the children hospitalised for Covid 19 symptoms. Median age was 9 years (1 – 17), 22 female and 30 male, 10 (19%) had a pre-existing neurological condition, 36 (69%) were black or Asian. 8 patients (15%) had isolated neurological or psychiatric features, only 12 (23%) had respiratory symptoms on admission.
The authors divided the cohort in two groups and described the neurological symptoms in each group:
- The COVID-19 neurology group: 27 (52%) patients
- 7 acute demyelinating syndromes: 1 optic neuritis (MOG+), 1 clinically isolated syndrome, 1 transverse myelitis and 4 ADEM (3 MOG antibodies+).
- 10 encephalopathy: 7 associated with status epilepticus (4 had pre-existing epilepsy), 1 MERS, 1 limbic encephalitis
- 5 peripheral neuropathy : 5 Guillain Barre syndromes (GBS)
- 2 mouvements disorders with choerea
- 2 psychosis
- The PIMS-TS neurology group: 25 (48%) patients
- 100% had systemic features
- 22 (88%) encephalopathy: 7 MERS, 1 PRES
- 10 (40%) peripheral nervous system involvement
- 10 meningism /headache
- 9 (36%) behavioral change: hallucinations (n=6, 24%)
- 4 (16%) seizures
- 2 strokes
- 1 ADEM with MOG antibodies+
Regarding the investigations: 31 (60%) had lumbar puncture (35% pleocytosis, 15% elevated CSF protein, oligoclonal bands positive in two patients, PCR RNA CSF negative in 6/6) ; 33 had an EEG (18 non-specific background slowing, 2 epileptic discharges) ; 15 had an ENMG (diffuse myopathic/neuropathy, demyelinating (GBS), focal changes, facial nerve involvement). Cerebral and spinal imaging were practiced in 48 patients, the abnormalities were related to the clinical syndrome (44% abnormalities in the COVID-19 group, 43% in the PIMS-TS group).
Regarding the prognosis, more children in PIMS-TS group were admitted to intensive care (n=20, 80% versus n=6, 22%) and receives immunomodulatory treatment (n=22 versus n=12).
34 patients (65%) had a good recovery (mRS sore 0-1), 17 (33%) had some degree of disability (mRS 2-5), one patient died (ischemic stroke) in the PIMS-TS group.
Our paper of the month was the first nation-wide cohort study describing neurological and psychiatric manifestations of SARS CoV2 infection in children and adolescents. The authors find a high prevalence (3.8%) and describe various manifestations that can affect both central and peripheral nervous system. Almost half of these manifestations were neuroimmune post infectious disorder, which is much higher than in the adults. More studies are needed to describe (i) the underlying pathogenesis for neurological involvement and (ii) the long-term outcomes of these manifestations.