Childhood focal compressive mononeuropathies during the COVID‐19 pandemic in Buenos Aires, Argentina

Abstract

Introduction/Aims: Focal peripheral neuropathies are infrequently seen in pediatric patients. The COVID-19 pandemic has disrupted normal life for many people, including complete lockdowns and school closing for long periods of time in many countries, which prompted children to stay at home. Our aim is to assess whether there has been an increased incidence of focal compressive peripheral neuropathies in the pediatric population during COVID-19-associated lockdown.Methods: Clinical, electrophysiological, and imaging characteristics were reviewed for patients referred to the electrodiagnostic (EDx) laboratory with suspicion of a focal neuropathy. The incidence of focal compressive peripheral neuropathies seen during the period of March to September 2020 was compared with the same time period in 2019.Results: An increased incidence of focal neuropathies was seen in 2020 (31%) compared with 2019 (6.8%). During 2020, 7 fibular (peroneal) mononeuropathies and 2 ulnar neuropathies were diagnosed. Most patients with focal neuropathies were underweight and acknowledged prolonged screen time periods. Electrophysiological findings consisted of mostly demyelinating lesions with an overall good clinical outcome.Discussion: In this study we raise awareness about a possible increased incidence of focal compressive peripheral neuropathies in children during COVID-19-associated lockdown, which may be prevented with changing positions during sedentary activities.

Isolated right peroneal mononeuropathy after silent SARS-CoV-2 infection in a child: Case report and review of the literature

“…The nervous system is commonly affected, and neurological manifestations can present as late complications of the disease challenging the clinician for the correct diagnosis [3,4]. In children, COVID-19 has a milder presentation, but with a wide range of symptoms and signs including neurological ones [1]. Patone et al using data from the English National Immunization (NIMS) Database of COVID-19 vaccination in England Early in the course of SARS-CoV-2 infection, patients develop headaches, dizziness, anosmia, and ageusia.…”

“…This resulted in a dramatic increase in screen viewing in the same body position. The mechanical compression of peripheral nerves could be the sole explanation of peripheral neuropathy [1].…”

“…Regarding SARS-CoV-2 peroneal mononeuropathy, Brand et al described an increased incidence of pediatric focal neuropathies in Buenos Ayres, Argentina, in 2020, i.e., the first year of the SARS-CoV-2 pandemic, a year when 7 peroneal and 2 ulnar mononeuropathies were diagnosed in pediatric patients in his center. Most patients were thin and acknowledged prolonged TV viewing, while electrophysiological studies showed demyelinating lesions with favorable prognosis [1]. Cioffi et al described a 59-year-old man with COVID-19-associated mononeuropathy presenting as acute weakness of the left peroneal muscles, who recovered after administration of intravenous immunoglobulin [6].…”

“…Peroneal neuropathy is considered the most common mononeuropathy of the lower extremities, albeit with limited bibliographic data [1,2]. It is slightly more common in males.…”

“…It is slightly more common in males. Risk factors include local injuries or recurrent minor trauma, surgery, weight loss, habitual leg crossing, other prolonged postures (e.g., squatting) or application of inappropriately fitted orthopedic devices that lead to uninterrupted pressure at the fibular head, intoxication, bicycle riding, prolonged anesthesia, lengthy hospitalization, other underlying neuropathies, and diabetes mellitus [1,2]. Exposure to cold and irradiation are additional causes [2].…”