Spectrum, Risk Factors, and Outcomes of Neurological and Psychiatric Complications of COVID-19: A UK-Wide Cross-Sectional Surveillance Study

Russell, Amy Ross; Jeyanantham, Athavan; White, Laura M.; Deb, Saumitro; Burnside, Girvan; Joy, Harriet; Smith, Craig J.; Pollak, Thomas A; Nicholson, Timothy; Davies, Nicholas W S; Manji, Hadi; Easton, Ava; Ray, Stephen; Zandi, Michael S; Coles, Jonathan P.; Menon, David; Varatharaj, Aravinthan; McCausland, Beth; Ellul, Mark; Thomas, Naomi; Breen, Gerome; Keddie, Stephen; Lunn, Michael; Burn, John; Quattrocchi, Graziella; Dixon, Luke; Rice, Claire M; Pengas, George; Salman, Rustam Al‐Shahi; Carson, Alan; Joyce, Eileen M.; Turner, Martin R.; Benjamin, Laura; Solomon, Tom; Kneen, Rachel; Pett, Sarah; Thomas, Rhys; Michael, Benedict; Galea, Ian

doi:10.2139/ssrn.3767901

Cited by 14 publications

(10 citation statements)

References 31 publications

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“…The neurological and psychiatric manifestations of COVID-19 have been reported in several studies in adults (age 18 years or older). 3 , 4 , 5 Similarities between our study and the adult CoroNerve cohort 25 include the range of disorders identified; although stroke prevalence was much higher in adults, present in almost half of the cases. Adults were also more likely to have multiple neurological diagnoses (13% of adult cases) than children and adolescents, perhaps suggesting there are multiple mechanisms linked to underlying risk factors and comorbidities.…”

Section: Discussionsupporting

confidence: 70%

Neurological manifestations of SARS-CoV-2 infection in hospitalised children and adolescents in the UK: a prospective national cohort study

Ray¹,

Abdel‐Mannan

et al. 2021

The Lancet Child & Adolescent Health

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138

185

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Background The spectrum of neurological and psychiatric complications associated with paediatric SARS-CoV-2 infection is poorly understood. We aimed to analyse the range and prevalence of these complications in hospitalised children and adolescents. MethodsWe did a prospective national cohort study in the UK using an online network of secure rapid-response notification portals established by the CoroNerve study group. Paediatric neurologists were invited to notify any children and adolescents (age <18 years) admitted to hospital with neurological or psychiatric disorders in whom they considered SARS-CoV-2 infection to be relevant to the presentation. Patients were excluded if they did not have a neurological consultation or neurological investigations or both, or did not meet the definition for confirmed SARS-CoV-2 infection (a positive PCR of respiratory or spinal fluid samples, serology for anti-SARS-CoV-2 IgG, or both), or the Royal College of Paediatrics and Child Health criteria for paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS). Individuals were classified as having either a primary neurological disorder associated with COVID-19 (COVID-19 neurology group) or PIMS-TS with neurological features (PIMS-TS neurology group). The denominator of all hospitalised children and adolescents with COVID-19 was collated from National Health Service England data. Findings Between April 2, 2020, and Feb 1, 2021, 52 cases were identified; in England, there were 51 cases among 1334 children and adolescents hospitalised with COVID-19, giving an estimated prevalence of 3•8 (95% CI 2•9-5•0) cases per 100 paediatric patients. 22 (42%) patients were female and 30 (58%) were male; the median age was 9 years (range 1-17). 36 (69%) patients were Black or Asian, 16 (31%) were White. 27 (52%) of 52 patients were classified into the COVID-19 neurology group and 25 (48%) were classified into the PIMS-TS neurology group. In the COVID-19 neurology group, diagnoses included status epilepticus (n=7), encephalitis (n=5), Guillain-Barré syndrome (n=5), acute demyelinating syndrome (n=3), chorea (n=2), psychosis (n=2), isolated encephalopathy (n=2), and transient ischaemic attack (n=1). The PIMS-TS neurology group more often had multiple features, which included encephalopathy (n=22 [88%]), peripheral nervous system involvement (n=10 [40%]), behavioural change (n=9 [36%]), and hallucinations at presentation (n=6 [24%]). Recognised neuroimmune disorders were more common in the COVID-19 neurology group than in the PIMS-TS neurology group (13 [48%] of 27 patients vs 1 [<1%] of 25 patients, p=0•0003). Compared with the COVID-19 neurology group, more patients in the PIMS-TS neurology group were admitted to intensive care (20 [80%] of 25 patients vs six [22%] of 27 patients, p=0•0001) and received immunomodulatory treatment (22 [88%] patients vs 12 [44%] patients, p=0•045). 17 (33%) patients (10 [37%] in the COVID-19 neurology group and 7 [28%] in the PIMS-TS neurology group) were discharged with disabili...

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Section: Discussionsupporting

confidence: 70%

Neurological manifestations of SARS-CoV-2 infection in hospitalised children and adolescents in the UK: a prospective national cohort study

Ray¹,

Abdel‐Mannan

et al. 2021

The Lancet Child & Adolescent Health

Self Cite

138

185

View full text Add to dashboard Cite

show abstract

“…Moreover, all domains of β 2 GPI have been described as targeted by antiphospholipid antibody, but the most clinically significant to date is antibodies to domain I [30] . The delayed presentation, in our case, is consistent with the recent description of a biphasic presentation of encephalopathy, with the delayed phase (approximately 20-days) reported as more severe [31] . The exact mechanism is unclear, and could be immune-mediated.…”

Section: Discussionsupporting

confidence: 91%

Antiphospholipid antibodies and neurological manifestations in acute COVID-19: A single-centre cross-sectional study

Benjamin¹,

Paterson²,

Moll³

et al. 2021

EClinicalMedicine

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Background A high prevalence of antiphospholipid antibodies has been reported in case series of patients with neurological manifestations and COVID-19; however, the pathogenicity of antiphospholipid antibodies in COVID-19 neurology remains unclear. Methods This single-centre cross-sectional study included 106 adult patients: 30 hospitalised COVID-neurological cases, 47 non-neurological COVID-hospitalised controls, and 29 COVID-non-hospitalised controls, recruited between March and July 2020. We evaluated nine antiphospholipid antibodies: anticardiolipin antibodies [aCL] IgA, IgM, IgG; anti-beta-2 glycoprotein-1 [aβ 2 GPI] IgA, IgM, IgG; anti-phosphatidylserine/prothrombin [aPS/PT] IgM, IgG; and anti-domain I β 2 GPI (aD1β2GPI) IgG. Findings There was a high prevalence of antiphospholipid antibodies in the COVID-neurological (73.3%) and non-neurological COVID-hospitalised controls (76.6%) in contrast to the COVID-non-hospitalised controls (48.2%). aPS/PT IgG titres were significantly higher in the COVID-neurological group compared to both control groups ( p < 0.001). Moderate-high titre of aPS/PT IgG was found in 2 out of 3 (67%) patients with acute disseminated encephalomyelitis [ADEM]. aPS/PT IgG titres negatively correlated with oxygen requirement (FiO 2 R =-0.15 p = 0.040) and was associated with venous thromboembolism ( p = 0.043). In contrast, aCL IgA ( p < 0.001) and IgG ( p < 0.001) was associated with non-neurological COVID-hospitalised controls compared to the other groups and correlated positively with d -dimer and creatinine but negatively with FiO 2 . Interpretation Our findings show that aPS/PT IgG is associated with COVID-19-associated ADEM. In contrast, aCL IgA and IgG are seen much more frequently in non-neurological hospitalised patients with COVID-19. Characterisation of antiphospholipid antibody persistence and potential longitudinal clinical impact are required to guide appropriate management.

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“…It is known that psychiatric illness, delirium, encephalopathy and encephalitis may complicate COVID-19 [4,5], and potential biomarkers exist to support these diagnoses alongside imaging changes [6]. In this patient, however, multiple negative SARS-CoV-2 PCR tests made this diagnosis less likely, although an asymptomatic COVID-19infection around the time of vaccination cannot be excluded.…”

Section: Table 1 Summary Of Investigationsmentioning

confidence: 81%

A case report of ChAdOx1 nCoV-19 vaccine–associated encephalitis

et al. 2021

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Background Vaccination against COVID-19 continues apace, but side-effects, both common and severe, continue to be reported. We report here the first published case of COVID-19 vaccine-related encephalitis. Case presentation A young woman presented with acute neuropsychiatric symptoms following recent ChAdOx1 nCoV-19 vaccination. Extensive investigation did not identify alternative causes. Conclusions This difficult case is here described, including presentation, investigation, and management. Further study on neuropsychiatric side-effects of COVID-19 vaccination, including investigation as to whether there may be a causal link, is required.

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Spectrum, Risk Factors, and Outcomes of Neurological and Psychiatric Complications of COVID-19: A UK-Wide Cross-Sectional Surveillance Study

Cited by 14 publications

References 31 publications

Neurological manifestations of SARS-CoV-2 infection in hospitalised children and adolescents in the UK: a prospective national cohort study

Neurological manifestations of SARS-CoV-2 infection in hospitalised children and adolescents in the UK: a prospective national cohort study

Antiphospholipid antibodies and neurological manifestations in acute COVID-19: A single-centre cross-sectional study

A case report of ChAdOx1 nCoV-19 vaccine–associated encephalitis

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