Neuro features common in children with SARS-CoV-2–related inflammatory syndrome

About 50 percent of children who develop Paediatric Inflammatory Multisystem Syndrome Temporally associated with SARS-CoV-2 (PIMS-TS) present with neurological features, according to a small study presented at AAN 2021.

PIMS-TS, or multisystem inflammatory syndrome in children (MIS-C), is a rare, post-infection complication of SARS-CoV-2, explained study author Dr Omar Abdel-Mannan from the Great Ormond Street Hospital for Children, London, UK.

“We found that many children experienced neurologic symptoms involving both the central and peripheral nervous systems,” he noted.

The study population comprised 46 individuals aged <18 years (median age 10.2 years, 65.2 percent male, 80.4 percent non-White) with PIMS-TS who presented at the Great Ormond Street Hospital, London, UK, between April 4 and September 1, 2020. The patients were followed up at 6 weeks and 6 months after discharge from hospital, with data on clinical features obtained from electronic medical records.

More than half of the patients (52.2 percent; n=24) reported new-onset neurological symptoms at presentation. Twenty-four patients experienced headaches, 14 experienced encephalopathy or delirium, 14 patients experienced dysarthria or dysphonia, nine experienced ataxia, dysmetria, or unsteady gait, eight experienced myopathy or neuropathy, and six experienced hallucinations. One patient had a seizure. [AAN 2021, abstract 008]

Sixteen patients underwent neuroimaging at baseline, seven of whom demonstrated abnormalities. Four patients had reversible splenium signal changes. Abnormalities were detected in all 17 patients who underwent electroencephalographic monitoring at baseline, which ranged from mild to severe encephalopathy.

At the 6-week follow-up, 11 patients had ataxia, 16 had dysmetria, 15 had abnormal saccades, 18 had proximal myopathy, three had axonal peripheral neuropathy, and 12 had emotional lability. At the 6-month follow-up, six patients had ataxia, 12 had dysmetria, seven had abnormal saccades, eight had proximal myopathy, three had axonal peripheral neuropathy, and seven had emotional lability.

Compared with the 22 patients who did not have neurological symptoms, those with neurological symptoms at baseline were more likely to require ventilation (54.2 percent vs 27.3 percent; n=13 vs 3; p=0.006) and had a longer duration of ventilation (1 vs 0 days; p=0.01). Those with neurological symptoms were also more likely to require inotropic support (62.5 percent vs 31.8 percent; p=0.03).

Median duration of hospitalization was numerically, but not significantly, increased in patients with neurological symptoms (12 vs 8.5 days; p=0.14), as was maximum C-reactive protein levels (311 vs 220 mg/L; p=0.14).

The results of this study showed that PIMS-TS patients have heterogenous neurological clinical and paraclinical features and neurological involvement is secondary to immune-mediated aetiologies, said Abdel-Mannan.

Although neurological abnormalities persisted at 6 weeks and 6 months, there was little functional impairment, he added.

“With this new inflammatory syndrome that develops after children are infected with the coronavirus, we are still learning how the syndrome affects children and what we need to watch out for,” he continued.

“More studies are needed involving more children and following children to see how this condition changes over time and if there are any longer-term neurocognitive effects,” he pointed out.