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Published on: May 19, 2020
Systemic Inflammation Is Associated With Neurologic Involvement in Pediatric Inflammatory Multisystem Syndrome
Mario Sa1, Luwaiza Mirza1, Michael Carter1
1From the Children's Neurosciences (M.S., V.G., T.H., K.L., J.-P.L., D.L., T.R., R.S., S.T., S.B., M.L.), Paediatric Intensive Care (M.C., J.H., J.K., M.M.), Department of Paediatric Neuroradiology (L.C.J., A.S.), Department of Congenital Heart Disease (O.M.), Department of Pediatric Rheumatology (V.S.), and Department of General Paediatrics (M.W.), Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust; Department of Women and Children's Health (L.M., M.C., J.H., J.K., O.M., M.W., M.L.), School of Life Course Sciences, King's College London; and Department of Neuroradiology (L.C.J., A.S.), King's College Hospital, London, United Kingdom.
Insights
Pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) can cause serious neurologic issues in children. Higher inflammatory markers in PIMS-TS patients with neurologic symptoms indicate a poorer prognosis.
Area of Science:
- Pediatric Neurology
- Infectious Diseases
- Immunology
Background:
- Pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) is a severe immune-mediated condition.
- Neurologic manifestations in children with PIMS-TS require further investigation.
Purpose of the Study:
- To describe the neurologic features observed in children diagnosed with PIMS-TS.
- To analyze the short-term outcomes and associated inflammatory markers in pediatric PIMS-TS patients with neurologic involvement.
Main Methods:
- Retrospective review of medical records for children diagnosed with PIMS-TS between March and June 2020.
- Identification of clinical presentations, neuroimaging findings, and short-term outcomes in patients with neurologic symptoms.
Main Results:
- Neurologic involvement was present in 12% of 75 PIMS-TS patients, including altered consciousness, behavioral changes, focal deficits, headaches, hallucinations, and seizures.
- Four patients had abnormal cranial imaging; at 3-month follow-up, one patient died, one had hemiparesis, and four recovered fully.
- Children with neurologic involvement exhibited higher systemic inflammatory and prothrombotic markers (CRP, procalcitonin, fibrinogen, d-dimers) compared to those without.
Conclusions:
- A significant proportion of children with PIMS-TS experience diverse neurologic symptoms.
- Elevated inflammatory markers are associated with neurologic involvement and poorer outcomes in pediatric PIMS-TS.
- While some patients experience persistent deficits, a portion achieve full recovery within three months.
Objective:
Pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) is a severe immune-mediated disorder. We aim to report the neurologic features of children with PIMS-TS.
Methods:
We identified children presenting to a large children's hospital with PIMS-TS from March to June 2020 and performed a retrospective medical note review, identifying clinical and investigative features alongside short-term outcome of children presenting with neurologic symptoms.
Results:
Seventy-five patients with PIMS-TS were identified, 9 (12%) had neurologic involvement: altered conciseness (3), behavioral changes (3), focal neurology deficits (2), persistent headaches (2), hallucinations (2), excessive sleepiness (1), and new-onset focal seizures (1). Four patients had cranial images abnormalities. At 3-month follow-up, 1 child had died, 1 had hemiparesis, 3 had behavioral changes, and 4 completely recovered. Systemic inflammatory and prothrombotic markers were higher in patients with neurologic involvement (mean highest CRP 267 vs 202 mg/L, p = 0.05; procalcitonin 30.65 vs 13.11 μg/L, p = 0.04; fibrinogen 7.04 vs 6.17 g/L, p = 0.07; d-dimers 19.68 vs 7.35 mg/L, p = 0.005). Among patients with neurologic involvement, these markers were higher in those without full recovery at 3 months (ferritin 2284 vs 283 μg/L, p = 0.05; d-dimers 30.34 vs 6.37 mg/L, p = 0.04). Patients with and without neurologic involvement shared similar risk factors for PIMS-TS (Black, Asian and Minority Ethnic ethnicity 78% vs 70%, obese/overweight 56% vs 42%).
Conclusions:
Broad neurologic features were found in 12% patients with PIMS-TS. By 3-month follow-up, half of these surviving children had recovered fully without neurologic impairment. Significantly higher systemic inflammatory markers were identified in children with neurologic involvement and in those who had not recovered fully.
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