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Neurological Manifestations of COVID-19 Associated Multi-system Inflammatory Syndrome in Children: A Systematic

Gaurav Nepal1, Gentle Sunder Shrestha2, Jessica Holly Rehrig3

  • 1Department of Internal Medicine, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal.

Journal of Nepal Health Research Council
|May 2, 2021
PubMed

Insights

Neurological symptoms are common in children with COVID-19 associated multisystem inflammatory syndrome (MIS-C). This review found headaches, meningitis, and encephalopathy in MIS-C patients, highlighting the need for further research.

Area of Science:

  • Pediatric neurology
  • Infectious diseases
  • Critical care medicine

Background:

  • Children represent a small percentage of COVID-19 cases.
  • COVID-19 associated multisystem inflammatory syndrome in children (MIS-C) can manifest with neurological symptoms.
  • Understanding neurological involvement in MIS-C is crucial.

Purpose of the Study:

  • To systematically review and meta-analyze neurological involvement in pediatric patients diagnosed with MIS-C.
  • To determine the prevalence of neurological manifestations in MIS-C.
  • To identify common and uncommon neurological signs and symptoms associated with MIS-C.

Main Methods:

  • Comprehensive literature search of major databases (PubMed, Embase, Scopus, etc.) for English language articles published from December 2019 to February 2021.
  • Systematic review and meta-analysis of proportions to calculate pooled prevalence with 95% confidence intervals.
  • Generation of forest plots to visualize individual study results and overall effect size.

Main Results:

  • Analysis of 15 studies involving 785 MIS-C patients.
  • Neurological manifestations were present in 27.1% of MIS-C patients.
  • Common symptoms included headache (27%), meningism/meningitis (17.1%), and encephalopathy (7.6%). Uncommon symptoms included anosmia, seizures, ataxia, weakness, and bulbar palsy.
  • Neuroimaging revealed corpus callosum signal changes; EEG showed slow waves; nerve conduction studies indicated mild myopathic/neuropathic changes.

Conclusions:

  • Neurological manifestations are frequently observed in children with MIS-C.
  • Further large-scale prospective studies are necessary to fully understand the spectrum of neurological involvement and the underlying pathophysiology of MIS-C.
Abstract

Keywords:
Children; COVID-19; kawasaki disease; MIS-C neurology.

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