A Comprehensive Review of Neurologic Manifestations of COVID-19 and Management of Pre-existing Neurologic Disorders in Children

Abstract

Since the first reports of SARS-CoV-2 infection from China, multiple studies have been published regarding the epidemiologic aspects of COVID-19 including clinical manifestations and outcomes. The majority of these studies have focused on respiratory complications. However, recent findings have highlighted the systemic effects of the virus, including its potential impact on the nervous system. Similar to SARS-CoV-1, cellular entry of SARS-CoV-2 depends on the expression of ACE2, a receptor that is abundantly expressed in the nervous system. Neurologic manifestations in adults include cerebrovascular insults, encephalitis or encephalopathy, and neuromuscular disorders. However, the presence of these neurologic findings in the pediatric population is unclear. In this review, the potential neurotropism of SARS-CoV-2, known neurologic manifestations of COVID-19 in children, and management of preexisting pediatric neurologic conditions during the COVID-19 pandemic are discussed.

Serum neurofilament light chain (sNfL) values in a large cross-sectional population of children with asymptomatic to moderate COVID-19

“…More surprisingly, raised levels were also found in adults with mild-to-moderate COVID-19 who were either neurologically asymptomatic or who exhibited only minor neurologic symptoms [7]. Our result is in line with findings in young adults < 35 years of age and suggests that children are less susceptible to neurologic involvement than older adults [1,7]. Further evidence of age dependency is provided by the higher rate of neurologic complications in older COVID-19 patients [11].…”

“…Multiple differences have emerged between adults and children in the clinical manifestations of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, with notable respect to severity, outcome, and neurological involvement [1][2][3]. In addition, in children with coronavirus disease 2019 , a multisystem hyperinflammatory syndrome has recently been identified, termed pediatric multiorgan immune syndrome (PMIS), which shares many clinical features with Kawasaki disease [4], including a presumed immune-mediated post-infectious etiology [5].…”

Post–COVID-19 Acute Disseminated Encephalomyelitis in a 17-Month-Old

“…al recently proposed that pediatric populations may be less susceptible to neurological complications of SARS-CoV-2 as ACE2 is expressed lowest in younger children. 25 Many other causes of encephalopathy can mimic ADEM and a complete evaluation is indicated. 26 Encephalopathy has a broad differential diagnosis and commonly results from an infectious agent such as a virus, bacteria, or arthropod-borne microorganism.…”

Primary prevention of COVID‐19: Advocacy for vaccination from a neurological perspective

“…4. Neurological complications of COVID-19, although rare, are also observed in neonates, children, and adolescents [10,11] The analysis of 121 decedents of COVID-19 younger than 21 years revealed preexisting medical disorders in 75%. The most frequently reported conditions were chronic lung disease, neurologic and developmental conditions, and cardiovascular disorders [12].…”

“…Many patients with COVID‐19 continue to complain of persistent symptoms, most of which are neurological in nature [8] These may include sequelae from injury to the central and peripheral nervous systems as well as a wide spectrum of symptoms termed post‐COVID‐19 syndrome [9]. Neurological complications of COVID‐19, although rare, are also observed in neonates, children, and adolescents [10,11] The analysis of 121 decedents of COVID‐19 younger than 21 years revealed preexisting medical disorders in 75%. The most frequently reported conditions were chronic lung disease, neurologic and developmental conditions, and cardiovascular disorders [12].…”