Social Science Research Network | 2021
Neurological and Psychiatric Manifestations of COVID-19 in UK Children: A Prospective National Cohort Study
Abstract
Background: The spectrum of neurological and psychiatric complications associated with COVID-19 is poorly understood in children. \n \nMethods: Children and adolescents (<18 years) with neurological or psychiatric disorders were included if paediatric neurologists considered SARS-CoV-2 infection to be relevant to the presentation. Cases were classified as having either a primary COVID-19 neurological/psychiatric disorder or as being associated with Paediatric Inflammatory Multisystem Syndrome Temporally associated with SARS-CoV-2 (PIMS-TS). The denominator of all hospitalised children with COVID-19 was collated from National Health Service England data. \n \nFindings: Fifty-two cases were identified, among 1334 children hospitalised with COVID-19 giving an estimated incidence of 3.8 per 100 children. Twenty-seven (52%) had a primary neurological or psychiatric disorder, 25 (48%) had features associated with PIMS-TS. The median (range) age was 9 (1-17) years.\xa0Thirty-six (69%) were from Black or Asian backgrounds. In the\xa0primary neurology/psychiatry disorder group, diagnoses included seven with status epilepticus, five encephalitis, five Guillain-Barre syndrome, three acute demyelinating syndromes, two chorea, two psychosis, two encephalopathy, one transient ischaemic attack.\xa0The PIMS-TS neurology group more often had multiple features, which included encephalopathy (22, 88%), peripheral nervous system involvement (10, 40%), behavioural change (9, 36%), hallucinations (6, 24%). A recognised neuro-immune disorder was more common in the primary neurology than the PIMS-TS neurology group (13/27 [48%] vs 1/25 [0.04%], p=0.0003). More patients in the PIMS-TS neurology group were admitted to intensive care (20/25 [80%] vs 6/27 [22%], p=0.0001) and received immunomodulatory treatment (22/25 [88%] vs 12/27 [44%]), p=0.045). Seventeen (33%) were discharged with disability; one PIMS-TS child with stroke died. \n \nInterpretation: This first nation-wide study of the neurological and psychiatric manifestations of COVID-19 in children identified key differences between those with a primary disorder versus those with PIMS-TS. More PIMS-TS children needed intensive care, but outcomes were similar overall. Further studies must investigate underlying mechanisms and longer-term outcomes. \n \nFunding Statement: BDM and GB are supported to conduct COVID-19 neuroscience research by the UKRI/MRC (MR/V03605X/1); for additional neurological inflammation research due to viral infection BDM is also supported by grants from the MRC/UKRI (MR/V007181//1), MRC (MR/T028750/1) and Wellcome (ISSF201902/3). SR is also supported by Wellcome to conduct paediatric neuroinfectious research (203919/Z/16/Z). IG is supported by NIHR. TS is supported by the National Institute for Health Research (NIHR) Health Protection Research Unit in Emerging and Zoonotic Infections (Grant Nos. IS-HPU-1112-10117 and NIHR200907), NIHR Global Health Research Group on Brain Infections (No. 17/63/110), the UK Medical Research Council’s Global Effort on COVID-19 Programme (MR/V033441/1), and the European Union s Horizon 2020 research and innovation program ZikaPLAN (Preparedness Latin America Network), grant agreement No. 734584. MG is supported to conduct neuroscience and infection research internationally by MRC Newton Fund (MR/S019960/1), MRC DPFS (MR/R015406/1) and NIHR (153195 17/60/67, 126156 17/63/11 and 200907). \n \nDeclaration of Interests: None. \n \nEthics Approval Statement: The study was approved by the University of Liverpool Institute of Infection Veterinary and Ecological Sciences Ethics Committee (UoL #7725/2020) and the University of Southampton Faculty of Medicine Ethics Committee (ERGO #56504). The electronic CRF was hosted on ALEA (www.aleaclinical.eu) and managed by the Clinical Information Research Unit.