Half of Children with Inflammatory Syndrome After COVID-19 Have Neurologic Symptoms

Approximately half of children with pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) present with new neurologic symptoms involving the central and peripheral nervous systems, in the absence of respiratory symptoms. Neurologic symptoms were seen more frequently in more severe presentations of PIMS-TS.

Children with neurologic involvement had higher peak inflammatory markers and were more likely to be ventilated and require inotropic support in PICU (P<0.05).
In a case series of 46 children (median age 10.2, 55% female sex, and 19.6 white), new-onset neurologic symptoms were reported in 24 (52.2%), including headaches (n=24), encephalopathy (n=14), dysarthria/dysphonia (n=6), hallucinations (n=6), ataxia (n=4), peripheral nerve involvement (n=3), and seizures (n=1). 

A single patient had 118 leukocytes in cerebrospinal fluid. Splenium signal changes were seen in 4 of 16 who had brain MRI. An excess of slow activity was found in 14 of 15 who had an EEG and myopathic and neuropathic changes were seen in 4 of 7 who had nerve conduction studies and electromyography (EMG). 

“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,” said Omar Abdel-Mannan, MD, University College, London. “We found that many children experienced neurologic symptoms involving both the central and peripheral nervous systems. Children who develop this condition should definitely be evaluated for neurologic symptoms and longer-term cognitive outcomes. 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.” 

For the study, clinical and paraclinical features were retrieved retrospectively from electronic records. Researchers reviewed the records of all children under 18 years of age admitted to Great Ormond Street Hospital in London between April and September 2020 who met the criteria for multisystem inflammatory syndrome in children (MIS-C). 

These data were presented at the American Academy of Neurology’s Virtual Annual Meeting 2021.