Increased neurologic involvement from COVID-19 in 2021

Neurologic involvement was seen in children and adolescents hospitalized for COVID-19 and multisystem inflammatory syndrome in children (MIS-C) in 2021 more than in 2020, according to a recent study.

Severe acute COVID-19 or MIS-C led to neurologic involvement in 22% of children and adolescents hospitalized in 2020. In June 2021, the Delta variant surged, causing further hospitalizations in the United States. 

To evaluate how COVID-19 and MIS-C affected neurologic development in children and adolescents in 2021, investigators conducted active surveillance at 55 hospitals across 31 US States that participated in the Overcoming COVID-19 public health surveillance network.

Participants included United States patients aged under 21 years with severe acute COVID-19 or MIS-C. COVID-19 was determined by positive respiratory test results, and MIS-C was determined by criteria from the Centers for Disease Control and Prevention. Patients were hospitalized any time from December 15, 2020, to December 31, 2021.

Data was gathered from medical records written by trained staff. Neurologic conditions and deficits included impairments to cognitive, motor, speech, and language functions. Data was also collected on race and ethnicity.

There were 2168 participants in the study, 22% of which has neurologic involvement. These patients were often older and had more underlying neurologic disorders. Younger children were more likely to experience seizures, and adolescents were more likely to experience loss of smell and taste.

Non–life-threatening neurologic symptoms were seen in 91% of patients with neurologic involvement. These symptoms included headache, fatigue, loss of taste and smell, and confusion. Survival without neurologic deficits was observed in 90% of these patients, while 5% died and 4% were discharged with neurologic deficits.

Life-threatening neurologic symptoms were seen in 9% of patients with neurologic involvement. Acute central nervous system or acute disseminated encephalomyelitis were seen in 55% of these patients.

Life-threatening neurologic conditions increased during the Delta period compared to pre-Delta rates, from 36% to 64%. Of those with life-threatening neurologic symptoms, 24% survived and were discharged with new neurologic deficits, while 19% died.

These results showed an increase in life-threatening neurologic conditions because of COVID-19 and MIS-C infection. Investigators believed that increasing vaccination efforts could reduce the number of neurologic complications.

Reference

LaRovere KL, Poussaint TY, Young CC, Newhams MM, Kucukak S, Irby K, et al. Changes in distribution of severe neurologic involvement in US pediatric inpatients with COVID-19 or multisystem inflammatory syndrome in children in 2021 vs 2020. JAMA Neurol. 2022. doi:10.1001/jamaneurol.2022.3881