Examining the neurological and psychiatric complications of COVID-19

We know a lot more about COVID-19 than we did when the pandemic started, but there are still aspects of the infection that are unknown. One is the neurologic and psychiatric complications related to infection. An investigation in The Lancet Child & Adolescent Health analyzed these issues in children and teenagers who had been hospitalized.¹

Investigators used an online network of secure rapid-response portals to run a prospective cohort study. They asked pediatric neurologists to note any pediatric patient admitted to the hospital with neurological or psychiatry disorders that they considered COVID-19 relevant to the presentation. The patients were divided into primary neurological disorder associated with COVID-19 (COVID-19 neurology group) or pediatric inflammatory multisystem syndrome temporally associated with COVID-19 (PIMS-TS) with neurological features (PIMS-TS neurology group).

There were 52 cases among 1334 children and teenagers who had been hospitalized with COVID-19, for an estimated prevalence of 3.8 cases per 100 pediatric patients. There were 27 patients in the COVID-19 neurology group and 25 were in the PIMS-TS neurology group. In the COVID-19 neurology group, the 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). Patients in the PIMS-S neurology group were found to more often have multiple features, including encephalopathy (n=22 [88%]), peripheral nervous system involvement (n=10 [40%]), behavioral change (n=9 [36%]), and hallucinations at presentation (n=6 [24%]). Neuroimmune disorders were more common in the COVID-19 neurology group. More children in the PIMS-TS neurology group went to intensive care and were given immunomodulatory treatment. Seventeen patients (10 in the COVID-19 neurology group and 7 in the PIMS-TS neurology group) were discharged from the hospital with disability and 1 participant in the PIMS-TS neurology group died.

The investigators concluded that although patients in the PIMS-TS neurology group were more likely to need intensive care, overall the outcomes were similar across both groups. They urged further study of the mechanisms for neurological involvement in COVID-19 as well as understanding the longer-term outcomes.

Reference

1. Ray S, Abdel-Mannan O, Sa M, et al. Neurological manifestations of SARS-CoV-2 infection in hospitalised children and adolescents in the UK: a prospective national cohort study. Lancet Child Adolesc Health. July 14, 2021. Epub ahead of print. doi:10.1016/s2352-4642(21)00193-0