Neurological Manifestations of Covid-19 In Children- An Indian Perspective

Objectives- COVID-19 infection is associated with varied neurological presentations. We present data of acute COVID-19-associated neurological illness(PCR/antibody-positive) from 2 tertiary-care centres across Mumbai. Methods- Retrospective observational study to analyse records of 88admitted patients with neurological symptoms over the three waves. Results- Acute neurological presentation in 88-patients admitted with COVID-19 related illness aged 1month-15years. Male:female was 1.6:1. Fifty-one were PCR-positive, 37antibody-reactive. Systemic features present in 70/88patients. Data classified as acute-encephalopathy(34), isolated seizures(23), neuropathy(12), stroke(11), movement-disorder(8). Acute-encephalopathy presented as demyelination(6), ANEC(5), leukoencephalopathy(4), virus-associated encephalopathy(19). One patient was MOG-positive, 1 NMDAR-positive. Stroke subgroup presented as 8 arterial strokes(3- posterior circulation, 2- MCA territory, 2- basal ganglia, 1-MCA+PCA territory) and 3cortical venous infarcts. Cranial-nerve neuropathies(3) were unilateral-palatal palsy(1) and isolated-facial palsy(2). GBS(9) was distributed as-AIDP(6), AMAN(2), AMSAN(1). Isolated seizures had status in2/21 cases. Movement disorders were dystonia(5), tremors and ataxia(3). EEG done in 35/88patients showed only background-slowing(14), interictal discharges(8), status(2), normal(11). Nine had co-existent TBM; 7antibody-positive, 2PCR-positive. One prior, 8-newly presented. Six patients had neurological predispositions (genetic epilepsy, tuberous sclerosis, craniopharyngioma, operated retinoblastoma, renal transplant). Intensive care was needed in 41/88 with 28requiring mechanical-ventilation, 30-immunomodulation (steroids, rituximab, tocilizumab, IVIG, plasmapheresis), 20-antithrombotic-treatment. Wave-1 had 27patients (11%incidence), wave-2 had 34(17%), wave-3 had 27(15%). Outcomes included no neurodeficit(43/88), discharge with neurodeficit(29/88) (hemiparesis, movement disorder, increased seizure frequency, aphasia, regression of milestones). Mortality in 4patients(2-TBM,1-basilar stroke,1-status epilepticus). Conclusion- SARS- CoV-2; respiratory pathogen, causes significant nervous system damage. All waves had similar incidence. Neuro-morbidity was significant with encephalopathy, movement disorders and GBS; isolated seizure patients recovered well.