Infectious Disease

Youngsters and adolescents with COVID-19 expertise a variety of neurological involvement

March 05, 2021

3 min read

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LaRovere does not report any relevant financial information. In the study you will find all relevant financial information from all other authors.

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Many children and adolescents with COVID-19 or multisystem inflammation syndrome had neurological involvement with largely temporary symptoms, according to a case series of nearly 1,700 patients published in JAMA Neurology.

“Although most children and adolescents are spared severe COVID-19, life-threatening neurological involvement has been reported in patients developing multisystemic childhood inflammatory syndrome (MIS-C), a relatively rare, hyperinflammatory, serious illness that occurs over time CoV-2 infection is associated with SARS, presumably post-infectious, ”the researchers wrote. “The frequency of neurological involvement in children hospitalized with acute COVID-19 is unclear. 150 of 4,190 patients were reported in nine international case series.”

Kerri LaRovere, MD, A member of the neurocritical care program in the Department of Neurology at Boston Children’s Hospital and an assistant professor of neurology at Harvard Medical School and colleagues wanted to determine the “extent and severity” of neurological involvement associated with COVID-19 in children and adolescents. Researchers conducted active surveillance at 61 hospitals in 31 states as part of the COVID-19 Overcoming Network to identify children and adolescents under the age of 21 who were diagnosed with SARS between March 15, 2020 and December 15, 2020 -CoV-2 related illness were hospitalized.

The case series also included patients who met the criteria for MIS-C. Patients with neurological involvement exhibited acute neurological signs, symptoms, or illnesses at the time of presentation or during hospitalization. The results included the type and severity of neurological involvement, laboratory and imaging data, and outcomes (death or survival with new neurological deficits) upon discharge from hospital as per study results.

Among 1,695 patients (54% boys and men; mean age 9.1 years) [interquartile range, 2.4-15.3 years]) only 22% (n = 365) of 52 sites had documented neurological involvement. LaRovere and colleagues found that patients with neurological involvement were more likely to have neurological disorders (81/365; 22%) than patients without neurological involvement (113 / 1,330; 8%). However, a similar number was previously healthy (195 [53%] against 723 [54%]) and met the criteria for MIS-C (126 [35%] 490 [37%]).

Most of the patients with neurological symptoms had transient symptoms and survived (n = 322; 88%). The researchers observed a “wide” range of neurological symptoms associated with COVID-19 that varied by age. These symptoms included seizures / status epilepticus in younger patients and reports of anosmia and / or ageusia, headache, and fatigue / weakness in the elderly. Among those who developed life-threatening conditions “clinically classified as associated with COVID-19” (n = 43; 12%), symptoms included severe encephalopathy (n = 15, 5 of which with splenic lesions), stroke (aft = 12). , Infection / demyelination of the central nervous system (n = 8), Guillain-Barré syndrome / variants (n = 4) and acute fulminant brain edema (n = 4).

The researchers found that patients with life-threatening neurological conditions compared to patients without life-threatening conditions (n ​​= 322) had a higher neutrophil to lymphocyte ratio (median 12.2 vs. 4.4) and a higher reported frequency of D-dimer had more than 3 g / ml fibrinogen equivalent units (21 [49%] 72 [22%]).

Among 43 patients who developed life-threatening neurological involvement related to COVID-19, 17 survivors (40%) showed new neurological deficits on discharge from hospital and 11 patients (26%) died. Among survivors with new neurological deficits, most (94%; n = 16) were previously healthy, none had previous neurological disorders, seven (41%) met the criteria for MIS-C and 14 (82%) required rehabilitation services after discharge.

LaRovere and colleagues recognized several limitations of the study, including the fact that cases of neurological involvement related to COVID-19 have only been identified in reporting hospitals and, therefore, “may not accurately reflect the actual scope and severity of neurological involvement from COVID-19 “. They also noted that certain neurological symptoms, such as anosmia or ageusia, may not have been adequately reported in very young patients and that the study was a case series rather than a retrospective cohort study.

“Future immunological studies on cell-mediated and cytokine immune responses in young people could provide insight into the pathogenesis of neurological diseases in COVID-19 and MIS-C. Patients with less severe neurological involvement could have future consequences, ”the researchers wrote. “Long-term follow-up of pediatric patients with COVID-19 related neurological involvement is needed to assess effects on cognition and development.”

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