The spectrum of SARS-CoV-2–related neurologic involvement among children and adolescents in 2021

By Bhavana KunkalikarNov 10 2022Reviewed by Danielle Ellis, B.Sc.

In a recent study published in JAMA Neurology, researchers explored the distribution of severe neurologic involvement in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pediatric patients.

Background

In 2020, 22% of hospitalized pediatric patients at 52 American sites showed neurologic involvement in multisystem inflammatory syndrome in children (MIS-C) or severe acute coronavirus disease 2019 (COVID-19), and 12% experienced serious sequelae. The SARS-CoV-2 Delta (B.1.617.2) variant became prevalent in June 2021, leading to increased pediatric hospitalizations in the US.

By 2021, children were eligible to receive COVID-19 vaccines. The present study evaluated patients hospitalized in 2021 with respect to the degree of SARS-CoV-2-related neurologic involvement and reported hospital outcomes in American adolescents and children, taking into account their status of COVID-19 vaccination.

About the study

In the present study, researchers described the extent of neurologic involvement caused by SARS-CoV-2 in children and adolescents.

The team conducted active surveillance of almost 55 hospitals across 31 states to recognize American patients aged over 21 years who were SARS-CoV-2-infected or who were eligible according to the criteria of Centers for Disease Control and Prevention (CDC) for children hospitalized with MIS-C between 15 December 2020, and 31 December 2021 with acute COVID-19 experienced symptoms that were consistent with COVID-19, as well as a positive SARS-CoV-2 reverse transcription-polymerase chain reaction (RT-PCR) or antigen test result. MIS-C patients had either a positive SARS-CoV-2 respiratory or antibody test result.

Qualified staff members extracted the required information from medical data. Medical data were employed to identify patients with severe deficits in motor, cognitive, language, and speech functions and life-threatening neurologic diseases.

Results

Of 2,168 patients, 58% were male, with a median age of 10.3 years. Among these, 34% experienced acute COVID-19, while 66% had MIS-C. Patients with neurologic involvement were generally older and exhibited more underlying neurologic illnesses. Younger children were more likely to experience seizures, while adolescents were more likely to experience a loss of smell and taste.

Almost 91% of patients with neurologic involvement experienced non-life-threatening neurological symptoms, with headache, disorientation, weakness, and loss of taste or smell being the most common. Furthermore, 90% of patients with non-fatal neurologic involvement survived without neurological impairment, 5% passed away, and 4% were discharged alive while still having neurologic deficits caused by the sequelae of their severe illness.

Out of 476 individuals with neurologic involvement, 42 exhibited a variety of life-threatening neurologic symptoms, including 23 with acute central nervous system (CNS) infection or acute disseminated encephalomyelitis (ADEM). Neurologic conditions that could be fatal were observed more frequently during the Delta wave of infections than during the pre-Delta phases. Of the 42 patients, 10 had new neurologic impairments at discharge, and eight succumbed to the disorders.

There were five confirmed and nine probable cases of encephalitis. Abnormalities on the electroencephalogram, like diffuse background slowing, localized seizures, or epileptic discharges, were observed. The majority of brain magnetic resonance imaging (MRI) results exhibited ADEM-like characteristics, including multifocal, non-enhancing lesions characterized with T2 prolongation as well as reduced diffusivity, primarily in the deep periventricular and juxtacortical white matter, basal ganglia, thalami, brainstem, and posterior fossa, while in one case, cortical interference in the supratentorium was noted.

The MRI of one patient displayed a low titer-positive for myelin oligodendrocyte glycoprotein antibody along with the involvement of the left temporal lobe that improved on a follow-up MRI performed after nine months. Seven of the 23 patients diagnosed with acute CNS infection/ADEM had serious outcomes. Of the 155 patients who were vaccine-eligible and had neurologic involvement with a confirmed COVID-19 vaccination status, 147 were not COVID-19-vaccinated, which included 15 of 16 patients with neurologic disorders that were life-threatening.

Conclusion

Overall, the study findings showed that in children and adolescents hospitalized due to MIS-C or COVID-19, SARS-CoV-2-related neurologic dysfunction persisted but was mainly transient. Disorders that were life-threatening more frequently involved CNS infection or demyelination, while most patients who were eligible to receive the COVID-19 vaccine were unvaccinated. Further research is needed to determine whether the COVID-19 vaccine can prevent some SARS-CoV-2-related neurologic sequelae.