Neurologic involvement common among children and adolescents with COVID-19

A case series of 1,695 children and adolescents hospitalized for coronavirus disease 2019 (COVID-19) finds neurological involvement in 22 percent of patients.

“Although most children and adolescents are spared from severe COVID-19, there have been reports of life-threatening neurologic involvement in patients developing multisystem inflammatory syndrome in children [MIS-C], a relatively rare, hyperinflammatory, severe illness temporally associated with severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2] infection,” wrote the researchers. [N Engl J Med 2020;383:347-358; N Engl J Med 2020;383:334-346]

In the current study, the researchers aimed to describe the type and severity of neurologic involvement and documented hospital outcomes using data from the Overcoming COVID-19 US public health surveillance registry of children and adolescents hospitalized with COVID-19–related complications. “Of patients aged <21 years hospitalized between 15 March 2020 and 15 December 2020 who had a positive SARS-CoV-2 test result [reverse transcriptase-polymerase chain reaction and/or antibody], 36 percent met the criteria for MIS-C,” they reported. [JAMA Neurol 2021, doi: 10.1001/jamaneurol.2021.0504]

Patients with neurologic involvement were more likely to have underlying neurologic disorders vs those without (22 percent vs 8 percent; p<0.001). However, patients who developed neurological involvement were as likely to have been previously healthy as those who were not (53 percent vs 54 percent; p=0.80) and as likely as not to meet the MIS-C criteria (35 percent vs 37 percent; p=0.45).

Among 365 patients with neurologic involvement, 43 (12 percent) had life-threatening neurologic involvement associated with COVID-19. Among these, 79 percent had no major underlying conditions, 47 percent met the criteria for MIS-C, and 7 percent had a pre-existing neurologic disorder. The three most common life-threatening neurologic conditions were severe encephalopathy (n=15), acute ischaemic or haemorrhagic stroke (n=12), and acute central nervous system infection/postinfectious central demyelination (n=8). “Eight patients with stroke had underlying risk factors, while four patients were previously healthy and did not have stroke risk factors,” noted the researchers.

Most patients with or without neurologic involvement were discharged alive (96 percent and 99 percent, respectively). However, in patients who developed life-threatening neurologic involvement, 26 percent died and 40 percent were discharged from hospital with new neurologic deficits (including cognitive impairment and painful neuropathy requiring gabapentin). Among survivors with new deficits, 94 percent were previously healthy, none had prior neurologic disorders, 41 percent met MIS-C criteria, and 82 percent required rehabilitative services on discharge.

“Presenting neurologic signs and symptoms differed by age, with seizures or status epilepticus most common in children <5 years of age, and anosmia and/or ageusia most common in patients between ages 13 and 20 years,” noted the researchers.