Some Children With Covid-Related Syndrome Develop Neurological Symptoms

Reports of the mysterious Covid-related inflammatory syndrome that affects some children and adolescents have mainly focused on physical symptoms: rash, abdominal pain, red eyes, and most importantly, heart problems such as low blood pressure, shock and difficulty pumping.

A new report now shows that a significant number of young people with the syndrome also develop neurological symptoms, including hallucinations, confusion, speech disorders, and problems with balance and coordination. The study of 46 children treated in a London hospital found that just over half (24) experienced neurological symptoms that they had never had before.

These patients were about twice as likely to need ventilators than those with no neurological symptoms because they were “very unwell in their hyperinflammatory state with systemic shock,” said a study author, Dr. Omar Abdel-Mannan, a clinical researcher at the Institute of Neurology at University College London. Patients with neurological symptoms were about twice as likely to need medication to improve the heart’s ability to push, he said.

The disease known as multisystem inflammatory syndrome in children (MIS-C) typically occurs two to six weeks after a Covid infection, which often causes only mild or no symptoms. The syndrome is rare but can be very serious. The latest data from the Centers for Disease Control and Prevention reports 3,165 cases in 48 states, Puerto Rico and the District of Columbia, including 36 deaths.

The new findings confirm the theory that the syndrome is related to a flare-up of inflammation triggered by an immune response to the virus, said Dr. Abdel-Mannan. In the children in the report, most of the neurological symptoms resolved when the physical symptoms were addressed.

Doctors in the United States also recently reported neurological symptoms in children with MIS-C. In a study published last month in JAMA Neurology, 126 of 616 young people with the syndrome enrolled in 61 US hospitals last year had neurological problems, including 20 with what researchers called “life-threatening” problems such as stroke or “severe encephalopathy”. ”

Updated

April 13, 2021, 5:17 p.m. ET

Unveiled as a preliminary study at an annual American Academy of Neurology conference on Tuesday, the new report assessed children under the age of 18 who were diagnosed with the syndrome (it) at Great Ormond Street Hospital (GOSH) between April and September last year. Has a different name and acronym (PIMS-TS, in Great Britain). The data are also included in a preprint of a larger study that has not yet been peer-reviewed.

As with other studies on the syndrome, including in the United States, the researchers stated that the majority of those affected were “not know”. This pattern, according to public health experts, reflects the disproportionate impact of the pandemic on color communities. Almost two thirds of the patients were male and the mean age was 10 years.

All 24 patients with neurological symptoms had headaches and 14 had encephalopathy, a general term that can include confusion, memory or attention problems, and other types of altered mental functions. Six of the children had hallucinations, including “describing people in the room who weren’t there or seeing cartoons or animals moving on the walls,” said Dr. Abdel-Mannan. He said some experienced auditory hallucinations involving “hearing voices from people who weren’t there.”

Six of the children had weakness or difficulty controlling the muscles used in speech. Four had balance or coordination problems. One child had seizures and three children had peripheral nerve abnormalities, including weakness in the muscles of the face or shoulder. A patient’s peripheral nerve damage resulted in a foot drop problem that required the use of crutches and a recommendation for a nerve transplant, said Dr. Abdel-Mannan, who also works in pediatric neurology at the GOSH.

Some of the patients had a brain exam, nerve conduction tests, or electroencephalograms (EEGs), including 14, which showed slower electrical activity in their brain.

13 of the 24 patients with neurologic symptoms needed ventilation and 15 needed medication to improve their heart contractions, said Dr. Abdel-Mannan. In contrast, only three of the 22 children with no neurological problems needed ventilators and seven such heart medications, he said. None of the children with hallucinations needed psychotropic drugs.

Three children had to be hospitalized again after their first stay, one for another episode of encephalopathy and two for infectious complications, said Dr. Abdel-Mannan, but he added that there were no deaths and “almost all of the children underwent full functional restoration. ”

Dr. Abdel-Mannan said a team led by the study’s lead author, Dr. Yael Hacohen, will follow patients with the syndrome – both those who had neurological symptoms and those who didn’t. They do brain scans and cognitive assessments to see if the children are experiencing long-term cognitive or psychological effects.

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