Neurological manifestations of SARS-CoV-2 infection in hospitalised children and adolescents in the UK: a prospective national cohort study

Abstract

Background The spectrum of neurological and psychiatric complications associated with paediatric SARS-CoV-2 infection is poorly understood. We aimed to analyse the range and prevalence of these complications in hospitalised children and adolescents. MethodsWe did a prospective national cohort study in the UK using an online network of secure rapid-response notification portals established by the CoroNerve study group. Paediatric neurologists were invited to notify any children and adolescents (age <18 years) admitted to hospital with neurological or psychiatric disorders in whom they considered SARS-CoV-2 infection to be relevant to the presentation. Patients were excluded if they did not have a neurological consultation or neurological investigations or both, or did not meet the definition for confirmed SARS-CoV-2 infection (a positive PCR of respiratory or spinal fluid samples, serology for anti-SARS-CoV-2 IgG, or both), or the Royal College of Paediatrics and Child Health criteria for paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS). Individuals were classified as having either a primary neurological disorder associated with COVID-19 (COVID-19 neurology group) or PIMS-TS with neurological features (PIMS-TS neurology group). The denominator of all hospitalised children and adolescents with COVID-19 was collated from National Health Service England data. Findings Between April 2, 2020, and Feb 1, 2021, 52 cases were identified; in England, there were 51 cases among 1334 children and adolescents hospitalised with COVID-19, giving an estimated prevalence of 3•8 (95% CI 2•9-5•0) cases per 100 paediatric patients. 22 (42%) patients were female and 30 (58%) were male; the median age was 9 years (range 1-17). 36 (69%) patients were Black or Asian, 16 (31%) were White. 27 (52%) of 52 patients were classified into the COVID-19 neurology group and 25 (48%) were classified into the PIMS-TS neurology group. In the COVID-19 neurology group, diagnoses included status epilepticus (n=7), encephalitis (n=5), Guillain-Barré syndrome (n=5), acute demyelinating syndrome (n=3), chorea (n=2), psychosis (n=2), isolated encephalopathy (n=2), and transient ischaemic attack (n=1). The PIMS-TS neurology group more often had multiple features, which included encephalopathy (n=22 [88%]), peripheral nervous system involvement (n=10 [40%]), behavioural change (n=9 [36%]), and hallucinations at presentation (n=6 [24%]). Recognised neuroimmune disorders were more common in the COVID-19 neurology group than in the PIMS-TS neurology group (13 [48%] of 27 patients vs 1 [<1%] of 25 patients, p=0•0003). Compared with the COVID-19 neurology group, more patients in the PIMS-TS neurology group were admitted to intensive care (20 [80%] of 25 patients vs six [22%] of 27 patients, p=0•0001) and received immunomodulatory treatment (22 [88%] patients vs 12 [44%] patients, p=0•045). 17 (33%) patients (10 [37%] in the COVID-19 neurology group and 7 [28%] in the PIMS-TS neurology group) were discharged with disabili...

Worldwide epidemiology of neuro-coronavirus disease in children: lessons for the next pandemic

“…In the broader published pediatric literature, neurological manifestations such as smell/taste disorders, headache, seizures, and stroke appear to predominate in acute COVID-19, whereas headache, encephalopathy, and MRI changes suggesting neuroinflammation predominate in MIS-C. Examples of neurological manifestations in children reported to date are summarized by clinical phenotype in Table 1 [ 60 , 61 , 62 ▪▪ , 63 ▪ , 64 , 65 ▪ , 66 , 67 ▪ , 68 – 75 , 76 ▪ , 77 , 78 ▪ , 79 , 80 ▪▪ ]. As these studies represent different pediatric cohorts (e.g.…”

“I can’t cope with multiple inputs”: Qualitative study of the lived experience of ‘brain fog’ after Covid-19

“…Surveys and focus groups conducted on online samples of mostly non-hospitalised long Covid patients have identified impairments in attentional processing, short-term memory and executive function, alongside a general, befuddled state termed 'brain fog' [4,6,8,19]. More recently concern has been raised that such effects may also extend to adolescents and children -a group generally considered to be at 'low risk' from Covid-19 infection [20]. A range of possible pathophysiologies have been identified, including direct neuroinvasion [21], viral persistence and chronic inflammation [22], neuronal injury or toxicity and glial activation [21], microvascular injury [23], activation of autoimmune mechanisms [24], and Lewy body production [25] amongst others, with imaging studies demonstrating a differential loss of grey matter in Covid patients in a number of key brain regions [26].…”

COVID-19 and mental health in children and adolescents: a diagnostic panel to map psycho-social consequences in the pandemic context

“…These include severe organ damage and the so-called longCOVID, which can also affect children [ 29 – 32 ]. However, there is now also a large scientific evidence that infection can also result in a number of neurological and psychiatric disorders, with up to 34% probability of occurrence within 6 months [ 31 – 38 ]. This constitutes both a direct risk for young people, but of course also an indirect one if severe health damage or mental illness affects the parents.…”

“…3 ). Severe courses of disease, longCOVID and psychological and neurological sequelae have an effect [ 29 – 31 , 34 – 38 , 74 , 75 ]. But in addition to the organic effects of potential viral diseases, the pandemic also has a psychological impact independent of the question of whether a child itself was infected.…”