Rare, but brain problems can result

By Dennis Thompson Health Day Reporter

TUESDAY July 20, 2021 (HealthDay News)

About one in 20 children hospitalized with COVID-19 develops debilitating brain or nerve complications that could haunt some for a long time, a new UK study reports.

Children with serious infections can suffer from inflammation of the brain, seizures, strokes, changes in behavior, hallucinations, and psychosis.

About a third of affected children had symptoms that did not resolve in the short term, although it is not known how long their brain problems will persist, the researchers said.

“Many of the children identified were very sick,” lead author Dr Rachel Kneen said in a press release from the University of Liverpool. “While they were at low risk of death, half needed intensive care support and a third had identified neurological disabilities. Many received complex drugs and treatments, often aimed at controlling their own immune systems. . “

Kneen, a pediatric neurologist at the Alder Hey Children’s NHS Foundation Trust in Liverpool, UK, said it would be important to follow these children to understand the long-term impact.

The United States Centers for Disease Control and Prevention estimates that about 1% of school-aged children with COVID-19 require hospitalization. Only 0.1% become so sick that they need care in an intensive care unit.

But children who also become ill with COVID-19 face the same type of serious health problems as adults, said Dr Ravi Jhaveri, acting chief of infectious diseases at the Children’s Hospital of Chicago.

“We have seen children suffer from the worst consequences of COVID-19 infection across the gamut, from bleeding complications, cardiac effects, now brain and nerve deficits, and symptoms potentially longer term termed “long haul”, “Jhaveri said.

For this study, British researchers collected data on pediatric neurological symptoms linked to COVID-19 using a nationwide real-time reporting system.

Out of 1,334 children under 18 hospitalized for COVID-19 from April 2020 to January 2021, investigators identified 52 who developed neurological complications.

The researchers further divided the cases between children who suffered from brain problems during their initial infection with COVID-19 and those whose symptoms developed as a result of multisystem inflammatory syndrome in children (MIS-C ). MIS-C is a severe inflammatory syndrome that usually occurs weeks after a child’s COVID-19 infection resolves.

Children who developed neurological problems during their COVID-19 infection suffered from conditions such as prolonged seizures, brain inflammation, Guillain-Barré syndrome and psychosis.

Those who later became ill with MIS-C had a different set of symptoms and were more likely to require intensive care, the study authors noted. Their symptoms included encephalopathy (brain dysfunction), stroke, change in behavior and hallucinations.

About two-thirds of the children apparently had good short-term results. The rest had some degree of persistent disability, according to the results.

It appears that the body’s immune response to COVID-19 could have a severe effect on children’s brain health, either during the initial infection or due to a subsequent MIS-C “cytokine storm” caused by the body’s overreaction of the immune system to coronavirus, said Dr Sanjeev Kothare, director of pediatric neurology at Cohen Children’s Medical Center in New Hyde Park, NY

Kothare noted that its center has treated around 50 patients with MIS-C following COVID-19 infection, including two or three who suffered seizures.

“Interestingly, the virus has rarely been detected in cerebrospinal fluid,” he said. “So it’s not a viral invasion of the brain. It’s the cytokine storm created by the virus in the body that crosses the blood-brain barrier and causes all of these symptoms.”

Symptoms in some of his patients persisted for at least six months, Kothare said.

Treatments are available for children with these symptoms, either by directly targeting their COVID-19 infection or by treating the neurological symptoms, Kothare and Jhaveri said.

But because cases are so rare, it’s hard to know what works best.

“Because the numbers are so small, a controlled study would be really difficult, and so we end up with small reports and case histories describing the results and maybe the differences in the treatment approach,” Jhaveri said. .

COVID-19 vaccines have yet to be approved for children under 12, but these results underscore the need for everyone else to get the vaccine and protect vulnerable children, he said.

“We cannot predict which children will get sick with severe symptoms, and so by widespread immunization of those who are eligible when they can get it, we can try to avoid the worst outcomes,” Jhaveri said.

And it’s similar to every other vaccine-preventable disease treated in history, including polio, measles and chickenpox, Jhaveri said.

“The story is essentially the same,” he said. “Even though a few children may suffer the worst consequences, the idea of ​​a population-wide vaccination strategy helps protect them.”

The results were recently published online in The Lancet Child and Adolescent Health.

More information

US Centers for Disease Control and Prevention has more on COVID-19 vaccines for children and adolescents, and COVID trends in school-aged children.

SOURCES: Ravi Jhaveri, MD, interim chief, infectious diseases, Ann & Robert H. Lurie Children’s Hospital of Chicago, and professor, pediatrics (infectious diseases), Northwestern University Feinberg School of Medicine, Chicago; Sanjeev Kothare, MD, director, pediatric neurology, Cohen Children’s Medical Center, New Hyde Park, NY; The Lancet Child and Adolescent Health, July 14, 2021, online

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