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Clinical characteristics and outcomes of COVID-19-associated encephalopathy in children

Li Li1, Hongmei Liao2,3, Xiaojun Kuang4

  • 1Department of Radiology, Hunan Children's Hospital, No. 86 Ziyuan Road, 410007, Changsha, Hunan, China.

Journal of Neurovirology
|April 3, 2024
PubMed

Insights

Coronavirus disease 2019 (COVID-19) can trigger brain disorders like encephalopathy and encephalitis in children. Autoimmune encephalitis is common, but acute necrotizing encephalopathy can lead to poor outcomes, though most children recover well.

Area of Science:

  • Neurology
  • Pediatrics
  • Infectious Diseases

Background:

  • Coronavirus disease 2019 (COVID-19) is known to cause respiratory symptoms.
  • Emerging evidence suggests COVID-19 also impacts the central nervous system, leading to encephalopathy and encephalitis.
  • Limited data exists on pediatric COVID-19-associated encephalopathy, especially concerning specific subtypes.

Purpose of the Study:

  • To assess the clinical features, neuroimaging and electroencephalography findings, treatment, and outcomes of pediatric COVID-19-associated encephalopathy/encephalitis.
  • To identify specific subtypes of encephalopathy/encephalitis in children with COVID-19.
  • To understand the neurological impact of COVID-19 on children.

Main Methods:

  • Retrospective analysis of a single cohort of 13 hospitalized children with confirmed COVID-19 and associated encephalopathy/encephalitis.
  • Descriptive analysis of clinical characteristics, magnetic resonance imaging (MRI) and electroencephalography (EEG) findings, treatment progression, and patient outcomes.
  • Categorization of encephalopathy/encephalitis subtypes including autoimmune encephalitis, acute necrotizing encephalopathy, epilepsy, and vasculitis.

Main Results:

  • Thirteen children (5% of 275 COVID-19 cases) developed encephalopathy/encephalitis (median age 35 months).
  • Subtypes included autoimmune encephalitis (6 patients), acute necrotizing encephalopathy (3), epilepsy (3), and vasculitis (1).
  • Seizures occurred in 62% of patients; 46% had elevated inflammatory markers. MRI and EEG findings varied by subtype. Acute necrotizing encephalopathy was associated with poor prognosis despite treatment, while 77% of children showed good recovery.

Conclusions:

  • COVID-19 is identified as a significant trigger for encephalopathy/encephalitis in pediatric populations.
  • Autoimmune encephalitis is a frequent subtype, whereas acute necrotizing encephalopathy presents a risk for poor outcomes.
  • The study provides crucial insights into the neurological manifestations of COVID-19 in children, emphasizing the need for further research and tailored management strategies.

Keywords:
Brain diseasesCOVID-19ChildEncephalitis

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