COVID-19 appears to make existing neurological conditions in kids worse

Cases of COVID-19 neurological damage in kids have been rare, but children with chronic neurological diseases have seen their conditions worsen, according to a child neurologist in Louisville.

“People have seen really small numbers of kids with rare complications spread across the country,” said Michael L. Sweeney M.D., a child neurologist with Norton Children’s Neuroscience Institute, affiliated with the UofL School of Medicine.

At Norton Children’s Hospital, neurological complications also have been rare, according to Dr. Sweeney.

“Locally, what we’ve really seen is kids who have chronic diseases have more severe complications,” Dr. Sweeney said.

For example, children with cerebral palsy who get COVID-19 may experience worsening spasticity.

Norton Children’s Neuroscience Institute also has seen a couple of rare complications from COVID-19, including a child who ended up being diagnosed with an anti-NMDA receptor encephalitis, according to Dr. Sweeney.

Lately, Norton Children’s Neuroscience Institute has seen an increasing number of referrals for so-called COVID-19 long-haulers, those who have long-lasting symptoms.

“These are chronic symptoms that patients have that haven’t been getting better over time, or have taken a long time to get better despite the infection being long gone,” Dr. Sweeney said.

One study that followed up with 518 children nine months after they were hospitalized for COVID-19 found 25% had persistent symptoms. The majority of patients’ complaints were for fatigue, insomnia or unrestful sleep, and ongoing trouble with smell or headaches.

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“So even though symptoms did improve … there was a significant number of patients who still had symptoms well after their acute presentation,” Dr. Sweeney said. “So we still haven’t figured out good ways to help these patients. We’re relying a lot on our therapists — physical therapy, occupational therapy — and hopefully we will improve our ways of helping these patients.”

For children acutely ill with COVID-19 who experienced neurological symptoms, the study found only about 5% of those children left the hospital with a new neurological deficit. The study did not cover whether this deficit was temporary or permanent.

Among patients with COVID-19 and multisystem inflammatory syndrome in children (MIS-C), data shows life-threatening neurologic conditions were quite rare, affecting only 2.5%. These conditions included severe encephalopathy, strokes, acute disseminated encephalomyelitis (ADEM) or post-infectious encephalitis, acute fulminant cerebral edema, and Guillain-Barré syndrome.

Other neurological deficits seen in children hospitalized with COVID-19 include acute facial paralysis, focal neuritis, spinal cord damage with signs of necrosis, and vascular events such as sinus venous thrombosis and a small infarction at the brainstem.

Among children hospitalized for COVID-19, a large U.S. study found 21% had some sort of neurological symptom while ill. The rate more than doubled, to 43%, in cases in which children had a preexisting neurological condition, representing both new symptoms and a continuation or worsening of previous symptoms.

By far, children with preexisting seizure disorders hospitalized with COVID-19 were the most likely to have neurological involvement. Neurological complications from COVID-19 were more common in more severe cases, such as children who needed to be in the intensive care unit. These neurological manifestations did not significantly alter their length of stay but increased the need to go to rehab and quadrupled the risk of death, from 1% to 4%.