Neuro-COVID-19 With or Without the Multisystem Inflammatory Syndrome (MIS-C): A Single-Center Study

Abstract

This study evaluates the range of neurological manifestation in children with COVID-19 (neuro-COVID-19) both with and without the multisystem inflammatory syndrome (MIS-C) and the persistence of symptoms after hospital discharge. The study was conducted as a prospective study of children and adolescents under 18 years of age who were admitted to a children’s hospital for infectious diseases from January 2021 to January 2022. The children had no previous neurological or psychiatric disorders. Out of the 3021 patients evaluated, 232 were confirmed to have COVID-19 and 21 of these patients (9%) showed neurological manifestations associated with the virus. Of these 21 patients, 14 developed MIS-C, and 7 had neurological manifestations unrelated to MIS-C. There was no statistical difference regarding the neurological manifestations during hospitalization and outcomes between patients with neuro-COVID-19 who had or did not have MIS-C, except for seizures that occurred more frequently in patients with neuro-COVID-19 without MIS-C ( p -value = 0.0263). One patient died, and 5 patients still had neurological or psychiatric manifestations at discharge, which persisted for up to 7 months. The study highlights that SARS-CoV-2 infection can affect the central and peripheral nervous system, particularly in children and adolescents with MIS-C, and that it is crucial to be vigilant for long-term adverse outcomes, as the neurological and psychiatric effects of COVID-19 in children are emerging during an important stage of brain development.

Elevated risk for psychiatric outcomes in pediatric patients with Multisystem Inflammatory Syndrome (MIS-C): A review of neuroinflammatory and psychosocial stressors

“… Hutchison et al (2020) Case study of a single 14-year-old boy Authors reported fluctuating impairments in awareness and attention, psychosis, and agitation that were typical of acute hyperactive delirium. Bentes et al (2023) Single-center prospective study of 3021 pediatric patients admitted to a hospital for infectious disease 232 patients were found to have COVID-19, and 21 of these patients (9%) showed neurological manifestations. 14/21 of these patients developed MIS-C. …”

“…The cause of inflammation, although inconclusive, does not seem to involve direct binding and replication of the SARS-CoV-2 virus in brain tissue. While there has been evidence of SARS-CoV-2 antibodies in the cerebrospinal fluid (CSF) of patients with COVID-19, there is no such evidence that exists in MIS-C literature ( Abdel-Mannanet et al, 2020 ; Bentes et al, 2023 ). Instead, researchers have attributed the possible causes of inflammation to cytokine storm syndrome, dysregulated immune responses after SARS-CoV-2 exposure, vascular dysfunction, and autoimmune mechanisms.…”