July 1, 2020

expert reaction to neurological effects of COVID-19 in children

A study, published in JAMA Neurology, looked at the neurological effects of COVID-19 in children.

Prof Angela Vincent, Honorary Professor, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, said:

“There are also emerging reports of a range of neurological complications in adults, from inflammatory brain or nerve conditions to strokes.  These disorders do not occur only in patients with severe infections and we are far from understanding how they arise but, as the authors of the childhood cases suggest, over-reactivity of the immune system is likely to be an underlying mechanism and provides scope for anti-inflammatory treatments.”

Dr. Ross W. Paterson MRCP PhD, Senior Clinical Research Fellow (UCL Queen Square Institute of Neurology) and Honorary Consultant Neurologist (National Hospital for Neurology and Neurosurgery and Darent Valley Hospital), said:

“This is a small but important study of four children who develop a distinctive pattern of nervous system inflammation in the context of COVID-19 infection. There are striking similarities to the neurological complications seen in adults.  

“This is further evidence that Covid-19 can cause injury to the brain and nervous system. We don’t yet know how damage occurs or why the nervous system is favoured.

“These cases raise important questions about how and why Sars-COV2 affects the nervous system over other organs.   

“The clinical improvement in response to immunotherapy is encouraging and may provide information about disease mechanism, but the number of patients in this study is small and prospective clinical trials would be needed.”

Dr Michael S. Zandi PhD FRCP, Consultant Neurologist, UCLH National Hospital for Neurology and Neurosurgery, said:

“COVID-19 has previously been thought to rarely affect children. This important study highlights how the brain can be involved as part of the emerging COVID-19 pediatric multisystem inflammatory syndrome. There are changes seen on brain imaging in the splenium of the corpus callosum quite characteristic of this syndrome, and this study will help others identify this complication early on, and offer tailored treatment to enable to the best chances of recovery. The long-term implications of COVID-19 on children’s brains and their development remains to be seen and long term follow up studies are needed.”

Dr Ming Lim MD PhD, Reader in Paediatric Neurology at King’s College London, Consultant Paediatric Neurologist at the Children’s Neurosciences Centre, Evelina London Children’s Hospital and King’s Health Partners Academic Health Science Centre, said:

“In recent months, a novel post-infection hyper-inflammatory syndrome now termed PIMS-TS (Paediatric multisystem inflammatory syndrome temporally associated with SARS-CoV2) has been identified in children. This group of children, now in excess of 150 cases seen in London and up to 300 in the UK, initially present with a high fever, rash, conjunctivitis and abdominal pain, progress to have multi-organ failure often requiring prolonged high-level intensive care support. PIMS-TS is distinct from the manifestations of COVID infections in adults and the prior reports of childhood COVID infection.

“In this paper, Abdel-Mannan and colleagues report 4 children from the first 27 patients with PIMS-TS seen at the largest children’s hospital in London, with a distinct clinical and radiological pattern of brain involvement. These children have encephalopathy (severe brain dysfunction), headaches, brainstem and cerebellar signs (critical abnormalities of neurological activity in the control of automatic function to survive like breathing and heartbeat), and profound muscle weakness; with distinct imaging changes involving splenium of the corpus callosum. At time of reporting, 2 of the children have been discharged from hospital within 2 weeks of admission to intensive care, whilst the other 2 have been moved from intensive care to the ward for neuro-rehabilitation.

“This case series is the first to report the neurological features affecting children with PIMS-TS that are only starting to be recognised, either at outset or through the course of acute disease. Importantly, the longer-term neurological course and subsequent sequelae of this condition now requires urgent evaluation. Furthermore, the long-term multisystem, particularly cardiac outcomes of PIMS-TS, including the potential for future relapse, and how these impact on health and neurological, psychological and cognitive outcome, are also unknown.”

‘Neurologic and Radiographic Findings Associated With COVID-19 Infection in Children’ by Omar Abdel-Mannan et al was published in JAMA Neurology at 4pm UK time on Wed 1 July 2020.

All our previous output on this subject can be seen at this weblink:

www.sciencemediacentre.org/tag/covid-19

Declared interests

Dr Paterson: no conflict of interest

Dr Zandi has received honoraria for lecturing from Eisai and UCB Pharma

Dr Lim: ‘I was clinical supervisor of the senior author (Yael Hacohen) of this manuscript during her doctoral studies in Oxford; have many collaborations including publications across the field of paediatric neuro-immunology with her; and pertinent to PIMS-TS, collaborating on a project to evaluate the long-term neurological sequelae following PIMS-TS using advanced imaging and biomarkers of neurodegeneration.’

None others received