Neurological Complications Associated with Multisystem Inflammatory Syndrome in Children (MIS-C)
Justin Esposito, 1Donald
1 BS ,
Dr. Sanjeev Kothare,
2 MD
and Barbara Zucker School of Medicine at Hofstra/Northwell, 2Department of Pediatric Neurology, Cohen Children’s Medical Center
Background
Preliminary Results
Methods
Coronavirus disease 2019 (COVID-19) has predominantly affected the adult population, with children accounting for 1% to 5% of diagnosed cases.
This study examined a dataset of 50 patients admitted to Cohen Children’s Medical Center with or suspected of having MIS-C.
Neurological symptoms were commonly reported at the time of diagnosis (100%) and at present follow-up (73.3%).
A growing number of pediatric cases have exhibited features of a multisystem inflammatory syndrome characterized by abdominal pain, gastrointestinal symptoms, and inflammatory involvement of the heart, lungs, kidneys, skin, and/or eyes – formerly described as Pediatric Multisystem Inflammatory Syndrome (PMIS) and now known as Multisystem Inflammatory Syndrome in Children (MIS-C)1.
The study included children between ages 0-17 years who tested positive for COVID-19, who have the existing diagnostic criteria of MIS-C, Kawasaki Disease, Toxic Shock Syndrome, or who have been suspected of having MIS-C.
The most reported neurologic symptom at diagnosis was headache (73.3%).
Data was collected through a phone interview/ questionnaire which inquired about neurological symptoms experienced as a result of COVID-19 and MIS-C. Patients were questioned about the presence of neurological symptoms before, during, and after the course of their disease.
40% of patients reported sleeping problems at present.
Previous research has investigated the presence of fever, diarrhea, shock, rash, conjunctivitis, and mucous membrane alterations in MIS-C2 , as well as the presence of acute neurological manifestations, including headache, encephalopathy, and radiographic findings3. However, little is known about the possible long-term neurologic complications of MIS-C such as seizures, headaches, sleep disturbances or irregularities, personality or mood changes, inattention, and feelings of apathy or indifference. Research into these factors will allow personalized treatment and strategies for rehabilitation for these children.
Hypothesis
The study hypothesizes that a fraction of patients with MIS-C in this COVID-19 pandemic dataset will have neurological sequelae.
Preliminary Results
Discussion The presence and qualities of neurologic symptoms at present follow-up suggest inflammatory involvement of the central nervous system in MIS-C. These findings could have implications for screening and treatment of these patients as well as expected long-term complications.
Proportion of Patients Reporting Neurological Symptoms at Diagnosis and at Present Apathy/…
Further research is needed to follow up with these patients to determine if these symptoms persist.
Pyschiatric Symptoms Attention
References
Sleeping Problem Headache Seizures Figure 7: Independent CRISPR knockout of CDK4 or CDK6 does not cause dropout in most breast cancer0cell lines0.1 studied.
At Present At COVID diagnosis
The most reported neurologic symptom at present was psychiatric symptoms, including personality, mood, or behavioral changes (53.3%).
0.2
Seizures
Headache
6.70% 0
13.30% 73.30%
0.3 Sleeping Problem 40% 53.30%
0.4
0.5
Attention 6.70% 20%
0.6
0.7
0.8
Pyschiatric Apathy/ Symptoms Indifference 53.30% 14.30% 46.70% 26.70%
Figure 1. Proportion of Patients Reporting Neurological Symptoms at Diagnosis and at Present
1. Whittaker, E., Bamford, A., Kenny, J., Kaforou, M., Jones, C. E., Shah, P., Ramnarayan, P., Fraisse, A., Miller, O., Davies, P., Kucera, F., Brierley, J., McDougall, M., Carter, M., Tremoulet, A., Shimizu, C., Herberg, J., Burns, J. C., Lyall, H., Levin, M., ... PIMS-TS Study Group and EUCLIDS and PERFORM Consortia (2020). Clinical Characteristics of 58 Children With a Pediatric Inflammatory Multisystem Syndrome Temporally Associated With SARS-CoV2. JAMA, e2010369. Advance online publication. https://doi.org/10.1001/jama.2020.10369 2. Chiotos, K., Bassiri, H., Behrens, E. M., Blatz, A. M., Chang, J., Diorio, C., Fitzgerald, J. C., Topjian, A., & John, A. (2020). Multisystem Inflammatory Syndrome in Children during the COVID-19 pandemic: a case series. Journal of the Pediatric Infectious Diseases Society, piaa069. Advance online publication. https://doi.org/10.1093/jpids/piaa069 3. Abdel-Mannan O, Eyre M, Löbel U, Bamford A, Eltze C, Hameed B, Hemingway C, Hacohen Y. Neurologic and Radiographic Findings Associated With COVID-19 Infection in Children. JAMA Neurol. 2020 Jul 1:e202687. doi: 10.1001/jamaneurol.2020.2687. Epub ahead of print. PMID: 32609336; PMCID: PMC7330822.