By Meaghan Lee Callaghan
Originally published by our sister publication, Pain Medicine News
New research found that among children with COVID-19 who develop multisystem inflammatory syndrome in children (MIS-C), about half had neurologic symptoms, including headache.
The researchers, who presented their study as an emerging science abstract at the 2021 virtual annual meeting of the American Academy of Neurology, noted that the children had no record of neurologic symptoms before COVID-19 infection.
“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 study author Omar Abdel-Mannan, BMBCh, a PhD candidate at University College London who is also completing his training in pediatric neurology at Great Ormond Street Hospital, in London, in a press release. “We found that many children experienced neurologic symptoms involving both the central and peripheral nervous systems.”
The 46 patients, with an average age of 10 years (interquartile range, 8.8-13.3 years) and mostly nonwhite (80.4%), were admitted to Great Ormond Street Hospital between April 4 and Sept. 1, 2020. Headaches were the most common neurologic symptom (24 patients), followed by encephalopathy (14), voice abnormalities or hoarseness (six), hallucinations (six) and ataxia (five). At the most uncommon, three children had peripheral nerve involvement and one child had seizures.
The study authors also noted that the children had higher peak inflammatory markers, and were more likely to be ventilated and require inotropic support in the pediatric ICU than their counterparts without neurologic symptoms (P<0.05). “Neurologic symptoms were seen more frequently in more severe presentations,” the authors wrote.
Although the greatest effects of COVID-19 are felt in adults, the earliest reports of inflammatory syndromes appearing in children date back to mid-spring 2020 (Lancet 2020;395[10239]:1741-1743). It was first thought to be a response similar to Kawasaki disease—a condition seen in very young children, including symptoms such as fever and rash that has an unknown origin—but increasing, divergent incidences of this COVID-19 pediatric inflammation necessitated its own diagnosis, now called multisystem inflammatory syndrome in children. “You probably have heard about these patients who have Kawasaki disease–like features temporally associated with COVID-19. We are also seeing patients with just myocarditis. We’re seeing patients with toxic shock, so it’s many different phenotypes. And it’s really hard to know exactly what is causing this,” Lauren Henderson, MD, MMSc, an attending physician in the rheumatology program and an assistant professor of pediatrics at Boston Children’s Hospital,told Infectious Disease Special Edition in May 2020.
The CDC defines MIS-C as an individual younger than 21 years of age presenting with fever, laboratory evidence of inflammation and COVID-19 infection, and evidence of clinically severe illness requiring hospitalization, with multisystem (two or more organ systems) organ involvement (cardiac, renal, respiratory, hematologic, gastrointestinal, dermatologic or neurologic) and fever of at least more than 38.0° C for at least 24 hours, or report of subjective fever lasting at least 24 hours.
However, other symptoms range from abdominal pain, vomiting and diarrhea to inflamed coronary arteries and myocarditis. With this new research, neurologic symptoms are added to the list.
“Children who develop this condition should definitely be evaluated for neurologic symptoms and longer-term cognitive outcomes,” Abdel-Mannan said in the press statement. “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.”
