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Half of pediatric patients presenting with multisystem inflammatory syndrome in children (MIS-C), a severe disorder associated with COVID-19, developed new-onset neurologic symptoms, a single-center British study showed.

Of 46 MIS-C patients presenting to Great Ormond Street Hospital in London between April 4 and Sept. 1, 2020, 24 (52.2%) had new neurologic involvement, reported Omar Abdel-Mannan, MD, of University College London, in an abstract released in advance of the American Academy of Neurology annual meeting. The findings will be presented as part of the meeting's on April 18.

Headache and encephalopathy were the most common neurologic symptoms. "With this new inflammatory syndrome that develops after children are infected with the coronavirus, we are still learning how the syndrome affects children and what we need to watch out for," Abdel-Mannan said in a statement. "We found that many children experienced neurologic symptoms involving both the central and peripheral nervous systems."

The median age of patients in the study was 10; about 65% were male and 80% were non-white. The researchers collected clinical and other data retrospectively from electronic health records.

All 24 pediatric patients had headache, 14 had encephalopathy, six had dysarthria or dysphonia, six had hallucinations, four had ataxia, three had peripheral nerve involvement, and one had seizures.

One patient had 118 leukocytes in cerebrospinal fluid. Four of 16 children who had brain MRI showed splenium signal changes. Four of seven patients who had nerve conduction studies and EMG had myopathic and neuropathic changes; 14 of 15 who had EEG had an excess of slow activity.

Neurological symptoms were seen more frequently in more severe presentations of MIS-C. Children with neurological involvement had higher peak inflammatory markers and were more likely to be ventilated and require inotropic support in the pediatric ICU (P<0.05).

A recent case series of 1,695 U.S. patients ages 21 or younger who were hospitalized with COVID-19 or MIS-C showed 22% had neurologic involvement. Most symptoms in that study were transient, but 12% of patients with neurologic involvement developed life-threatening problems, including encephalopathy, stroke, and central nervous system infection or demyelination.

Children who develop MIS-C, also known as pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) in some countries, "should definitely be evaluated for neurologic symptoms and longer-term cognitive outcomes," Abdel-Mannan said. "More studies are needed involving more children and following children to see how this condition changes over time and if there are any longer-term neurocognitive effects."

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