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Neurologic symptoms in children with multisystem inflammatory syndrome

AAN 2021
There is a new inflammatory syndrome associated with COVID-19, called paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS), also known as multisystem inflammatory syndrome in children (MIS-C). In a single-centre study, over half of these patients had neurologic symptoms at presentation affecting central and peripheral nervous system; after 6 months, symptoms persisted in one third of these patients.

Between 4 April and 1 September 2020, a total of 46 children (median age 10.2) who fulfilled the PIMS-TS criteria were admitted to the Great Ormond Street Hospital, UK [1]. The children were predominantly male (65.2%) and of non-white ethnicities (80.4%). Neurologic symptoms in these patients were analysed at baseline and at 6 weeks and 6 months post-discharge.

At baseline, 24 children (52%) showed neurological symptoms they had not had before, while respiratory symptoms were absent. Both central and peripheral nervous system manifestations were reported. The most commonly described symptoms were headache (52%), encephalopathy (30.4%), voice abnormalities (30.4%), coordination deficits (19.6%), myopathy/neuropathy (17.4%), and hallucinations (13.0%). Brain MRI was performed for 16 patients at baseline, 7 of which showed abnormalities. In all 17 patients who underwent EEG monitoring at baseline, abnormalities were found. Children with neurological involvement of PIMS-TS had higher peak inflammatory markers and were more likely to be ventilated and require inotropic support (P<0.05).

At 6 months follow-up, neurological manifestations persisted in one-third of the population, but with few functional problems. Commonly reported neurological symptoms at 6 months follow-up were dysmetria (26%), ataxia (13.0%), abnormal saccades (15.2%), proximal myopathy (17.4%), peripheral neuropathy (6.5%), and emotional lability (15.2%).

  1. Abdel-Mannan O, et al. Neurologic and radiographic findings associated with Pediatric Inflammatory Multisystem Syndrome Temporally associated with SARS-CoV-2 (PIMS-TS) in Children. ES.008, AAN 2021 Virtual Congress, 17-22 April.

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