Neurological symptoms in children with inflammatory syndrome following COVID-19

Over 50% of the children who presented at the Great Ormond Street Hospital, UK with Paediatric Inflammatory Multisystem Syndrome Temporally associated with SARS-CoV-2 (PIMS-TS) experienced neurological symptoms. Dr Omar Abdel-Mannan (University College London, UK) presented the results of a population-based study investigating neurological manifestations in children with PIMS-TS [1].

PIMS-TS, a rare complication following a SARS-CoV-2 infection, has been described as a multisystem condition including neurological involvement. The aims of this study were to report neurological manifestations in children presenting with PIMS-TS and comparing the children with and without neurological symptoms. Between 4 April and 1 September 2020, a total of 46 children (median age 10.2) fulfilled the PIMS-TS criteria. The children were predominantly male (65.2%) and of non-white ethnicities (80.4%). Neurological symptoms were analysed at baseline and at 6 weeks and 6 months post-discharge follow-up.

At baseline, 52% of the children showed neurological symptoms. Both central and peripheral nervous system manifestations were reported. The most commonly described neurological 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 them showed abnormalities. In all 17 patients who underwent EEG monitoring at baseline, abnormalities were found.

At 6 months follow-up, the proportion of neurological manifestations had dropped to one third of the population. 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%). Patients with neurological manifestations at baseline were ventilated more often and for a longer period of time. No other differences between the children with or without neurological symptoms were found in terms of demographics, systemic inflammation, or duration of hospital stay.

Dr Abdel-Mannan stressed the importance of the simultaneous involvement of central and peripheral symptoms, which is rare in paediatrics. Next to that, he mentioned that the children with neurological symptoms at baseline had been feeling more unwell prior to presentation at the hospital. Neurological symptoms persisted at 6 months follow-up, but with few functional problems.

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.

Posted on 20 April, 202117 June, 2021