Coronavirus Infections in the Nervous System of Children: A Scoping Review Making the Case for Long-Term Neurodevelopmental Surveillance

Timothy G Singer; Karen D Evankovich; Kristen Fisher; Gail J Demmler-Harrison; Sarah R Risen

doi:10.1016/j.pediatrneurol.2021.01.007

Coronavirus Infections in the Nervous System of Children: A Scoping Review Making the Case for Long-Term Neurodevelopmental Surveillance

Pediatr Neurol. 2021 Apr:117:47-63. doi: 10.1016/j.pediatrneurol.2021.01.007. Epub 2021 Jan 29.

Authors

Timothy G Singer¹, Karen D Evankovich², Kristen Fisher³, Gail J Demmler-Harrison⁴, Sarah R Risen³

Affiliations

¹ Baylor College of Medicine, Global Child Health Residency, Texas Children's Hospital, Houston, Texas. Electronic address: timothy.singer@bcm.edu.
² Baylor College of Medicine, Department of Pediatrics, Sections of Psychology and Neurology, Texas Children's Hospital, Houston, Texas.
³ Baylor College of Medicine, Department of Pediatrics, Section of Neurology and Developmental Neuroscience, Texas Children's Hospital, Houston, Texas.
⁴ Baylor College of Medicine, Pediatric Infectious Disease, Texas Children's Hospital, Houston, Texas.

PMID: 33676141
PMCID: PMC7988307
DOI: 10.1016/j.pediatrneurol.2021.01.007

Abstract

Background: The objective of this study was to describe the case literature of human coronavirus infections in the nervous system of children, including from SARS-CoV-2, and to provide guidance to pediatric providers for managing the potential long-term effects on neurodevelopment of human coronavirus infections in the nervous system.

Methods: Using a structured strategy, the PubMed and Ovid:Embase databases were queried for articles about the clinical presentation and pathophysiology of coronavirus infections in the nervous system of children and young adults, aged 0 to 24 years.

Results: Of 2302 articles reviewed, 31 described SARS-CoV-2 infections in the nervous system of children and 21 described other human coronaviruses: HCoV-229E, HCoV-NL63, HCoV-OC43, HCoV-HKU1, MERS-CoV, SARS-CoV-1. Excepting MERS-CoV, we found cases of neurological disease in children from each human coronavirus. Children with non-SARS-CoV-2 infections have suffered acute flaccid paralysis, acute disseminated encephalomyelitis, encephalitis, and seizures. In addition, cases of ischemic, hemorrhagic, and microvascular strokes have occurred in children with SARS-CoV-2. Patients with multisystem inflammatory syndrome in children have suffered encephalitis, stroke, pseudotumor cerebri syndrome, and cytotoxic lesions of deep brain structures. Despite these reports, few articles evaluated the impact of human coronavirus infections on long-term neurodevelopmental domains including cognitive, language, academic, motor, and psychosocial outcomes.

Conclusions: Neurological manifestations of human coronavirus infections can cause severe disease in children. The case literature suggests a critical gap in knowledge of the long-term effects on child neurodevelopment of these infections. As the current SARS-CoV-2 pandemic continues, this gap must be filled to facilitate optimal outcomes in recovering children.

Keywords: COVID-19; Coronavirus; Encephalitis; Multisystem inflammatory syndrome in children; Neurodevelopmental outcomes; Pediatric; SARS-CoV-2.

Publication types

Review

MeSH terms

Adolescent
Age Factors
COVID-19 / complications*
Child
Child, Preschool
Humans
Infant
Infant, Newborn
Nervous System Diseases / diagnosis*
Nervous System Diseases / virology*
Neurodevelopmental Disorders / diagnosis*
Neurodevelopmental Disorders / virology*
Population Surveillance*
Time Factors