Reports of the mysterious Covid-related inflammatory syndrome plaguing some children and teens have mostly focused on physical symptoms: rash, abdominal pain, red eyes and, most severely, heart problems such as low blood pressure, shock and problems with pumping.
Now, a new report shows that a significant number of young people with the syndrome also develop neurological symptoms, including hallucinations, confusion, speech impairments and problems with balance and coordination. The study of 46 children treated in one hospital in London found that just over half – 24 – experienced such neurological symptoms, which they had never had before.
It was about twice as likely that patients without neurological symptoms needed ventilators because they were ‘very bad with systemic shock as part of their hyperinflammatory condition’, said a study author, Dr. Omar Abdel-Mannan, a clinical research fellow, said. at the University College London’s Institute of Neurology. Patients with neurological symptoms are also about twice as likely to need medication to improve the heart’s ability to squeeze, he said.
The condition, called Multisystem Inflammatory Syndrome in Children (MIS-C), usually occurs two to six weeks after a Covid infection, often one that produces only mild symptoms or no symptoms at all. The syndrome is rare but can be very serious. The latest data from the Centers for Disease Control & Prevention reported 3,165 cases in 48 states, Puerto Rico and the District of Columbia, including 36 deaths.
The new findings reinforce the theory that the syndrome is associated with a surge of inflammation caused by an immune response to the virus, Drs. Abdel-Mannan said. For the children in the report, the neurological symptoms mostly resolved after the physical symptoms were treated.
Doctors in the United States have also recently reported neurological symptoms in children with MIS-C. In a study published in JAMA Neurology last month, 126 out of 616 young people with the syndrome admitted to 61 U.S. hospitals last year had neurological problems, including 20 with what the researchers described as “life-threatening” problems such as strokes. or “severe encephalopathy.”
The new report, presented as preliminary research on Tuesday as part of an annual conference of the American Academy of Neurology, evaluated children under the age of 18 who were admitted to Great Ormond Street Hospital (GOSH) between April and September last year. with the syndrome (it has a different name and acronym, PIMS-TS, in Britain). The data were also included in a preview of a larger study that has not yet been peer-reviewed.
As was the case with other studies of the syndrome, also in the United States, the researchers said that a majority of the affected people are ‘non-white’, a pattern that public health experts believe is the excessive way pandemic affected the color communities. Almost two thirds of the patients were male and the mean age was 10.
All 24 patients with neurological symptoms have headaches and 14 have encephalopathy, a common term that can include confusion, problems with memory or attention and other forms of mental function. Six of the children experienced hallucinations, including ‘describing people in the room who were not there or seeing cartoons or animals moving on the walls,’ said Dr. Abdel-Mannan said. He said that there were experienced auditory hallucinations regarding ‘hearing the voices of people who are not present’.
Six of the children experienced weakness or difficulty controlling muscles used in speech. Four had problems with balance or coordination. One child had seizures and three children had peripheral nerve disorders, including weakness in the facial or shoulder muscles. The peripheral nerve damage of one patient led to a footfall problem requiring the use of crutches and a recommendation for a nerve transplant, says Dr. Abdel-Mannan, who is also a senior resident in pediatric neurology at GOSH.
Some of the patients underwent brain scans, nerve conduction tests or electroencephalograms (EEGs), including 14 that showed slower electrical activity in their brains, the study reported.
Thirteen of the 24 with neurological symptoms had to be placed on ventilators and 15 needed medication to improve their heart contractions, said dr. Abdel-Mannan said. By contrast, only three of the 22 children without neurological problems needed ventilators and seven needed such medication, he said. None of the children with hallucinations needed psychotropic medication.
Three children had to be readmitted to hospital after their initial stay, one for another episode of encephalopathy and two for infectious complications, Dr. Abdel-Mannan said, however, he added that there were no deaths and ‘almost all children had a full functional recovery. ”
Dr Abdel-Mannan said that a team led by the senior author of the study, dr. Yael Hacohen, patients will follow who have had the syndrome – both those who had neurological symptoms and those who did not. They will do brain scans and do cognitive assessments to see if the children are experiencing long-term cognitive or psychological effects.