This shows a child in a face mask.
Children with prior MIS-C were also more likely to have psychosomatic symptoms like headaches, chest pain, back pain, nausea, and fatigue and tended to report a lower quality of life. Credit: Neuroscience News

MIS-C and COVID-19: Unmasking Hidden Neurological Aftershocks in Kids

Summary: Children who suffered from MIS-C, post-COVID-19 exposure, might face long-term neurologic and psychosocial challenges. Researchers found that these children had a higher rate of neurological abnormalities and experienced conditions such as impaired memory, anxiety, and even ADHD.

The study emphasizes the need for ongoing neurological assessments and support for such children. The findings shed light on the potential overlap with ‘brain fog’ in adults post-COVID.

Key Facts:

  1. Children with MIS-C, after COVID-19 exposure, showed higher neurological irregularities than the control group.
  2. Many of these children reported issues like impaired memory, motor coordination abnormalities, ADHD, anxiety, and depression.
  3. These findings hint at a potential connection between MIS-C in children and the ‘brain fog’ symptom experienced by adults after COVID-19.

Source: Boston Children’s Hospital

Children and adolescents who have had multisystem inflammatory syndrome in children (MIS-C) after exposure to COVID-19 are recommended to have follow-up heart function testing.

A new study from Boston Children’s Hospital suggests they should also be monitored for long-term neurologic and psychosocial complications.

“If parents are noticing changes in their child’s behavior or functioning, it could be related to MIS-C, and they should seek support,” says study leader Caitlin Rollins, MD, in the Department of Neurology and Cardiac Neurodevelopmental Program.

Cardiologists and pediatricians who care for children after MIS-C should also ask about the child’s mental and neurologic health and refer them for evaluation and support if there are any concerns, she says.

Memory, motor, and mental health problems

The study, published in JAMA Network Open, enrolled 64 children and adolescents who had been hospitalized with MIS-C at Boston Children’s from November 2020 through November 2021. Six to 12 months after discharge, the children underwent neurological examinations and detailed neuropsychological assessments.

For comparison, Dr. Rollins and her colleagues also assessed 44 siblings and nearby friends or relatives who had not had MIS-C.

Significantly more children with previous MIS-C had abnormal neurological findings than did children in the comparison group (25 versus 7%).

Neuropsychological findings included impaired working memory; motor, coordination, and gait abnormalities; and higher rates of diagnosed ADHD, anxiety, or depression.

Children with prior MIS-C were also more likely to have psychosomatic symptoms like headaches, chest pain, back pain, nausea, and fatigue and tended to report a lower quality of life.

Dr. Rollins notes that many of these symptoms could be chalked up to stress, including the stress of the COVID-19 pandemic and the way it upended children’s school and routines. Because the study included a comparison group that did not have MIS-C—but faced many of the same stressors—she believes the symptoms are likely MIS-C-related.

“When families learn the child’s symptoms could be related to MIS-C, they are reassured that others are experiencing it,” she says. “We hope this study will increase awareness.”

Related to adult ‘brain fog’?

Rollins is currently following the children with MIS-C for a second year and hopes to add MRI studies of the brain to see if MIS-C caused any structural changes.

In future studies, she hopes to explore how MIS-C predisposes children to neurobehavioral complications and what these children might have in common with adults who report brain fog after COVID-19.

As a committee member on the large RECOVER study, she has reviewed data from children who have had COVID-19 or MIS-C as well as adults with long COVID.

“These conditions are very intertwined,” says Rollins.

“The acute illness is very different—children with MIS-C are very sick and often need ICU care, while adults may have mild acute cases of COVID-19 but have lingering brain fog. Both could be part of the same spectrum and the same mechanisms could be underneath.”

About this neurology and COVID-19 research news

Author: Caitlin Rollins
Source: Boston Children’s Hospital
Contact: Caitlin Rollins – Boston Children’s Hospital
Image: The image is credited to Neuroscience News

Original Research: Open access.
Neurological and Psychological Sequelae Associated With Multisystem Inflammatory Syndrome in Children” by Caitlin K. Rollins et al. JAMA Network Open


Abstract

Neurological and Psychological Sequelae Associated With Multisystem Inflammatory Syndrome in Children

Importance 

 Acute neurological involvement occurs in some patients with multisystem inflammatory syndrome in children (MIS-C), but few data report neurological and psychological sequelae, and no investigations include direct assessments of cognitive function 6 to 12 months after discharge.

Objective 

 To characterize neurological, psychological, and quality of life sequelae after MIS-C.

Design, Setting, and Participants  

This cross-sectional cohort study was conducted in the US and Canada. Participants included children with MIS-C diagnosed from November 2020 through November 2021, 6 to 12 months after hospital discharge, and their sibling or community controls, when available. Data analysis was performed from August 2022 to May 2023.

Exposure  

Diagnosis of MIS-C.

Main Outcomes and Measures 

 A central study site remotely administered a onetime neurological examination and in-depth neuropsychological assessment including measures of cognition, behavior, quality of life, and daily function. Generalized estimating equations, accounting for matching, assessed for group differences.

Results 

 Sixty-four patients with MIS-C (mean [SD] age, 11.5 [3.9] years; 20 girls [31%]) and 44 control participants (mean [SD] age, 12.6 [3.7] years; 20 girls [45%]) were enrolled. The MIS-C group exhibited abnormalities on neurological examination more frequently than controls (15 of 61 children [25%] vs 3 of 43 children [7%]; odds ratio, 4.7; 95% CI, 1.3-16.7). Although the 2 groups performed similarly on most cognitive measures, the MIS-C group scored lower on the National Institutes of Health Cognition Toolbox List Sort Working Memory Test, a measure of executive functioning (mean [SD] scores, 96.1 [14.3] vs 103.1 [10.5]).

Parents reported worse psychological outcomes in cases compared with controls, particularly higher scores for depression symptoms (mean [SD] scores, 52.6 [13.1] vs 47.8 [9.4]) and somatization (mean [SD] scores, 55.5 [15.5] vs 47.0 [7.6]). Self-reported (mean [SD] scores, 79.6 [13.1] vs 85.5 [12.3]) and parent-reported (mean [SD] scores, 80.3 [15.5] vs 88.6 [13.0]) quality of life scores were also lower in cases than controls.

Conclusions and Relevance 

 In this cohort study, compared with contemporaneous sibling or community controls, patients with MIS-C had more abnormal neurologic examinations, worse working memory scores, more somatization and depression symptoms, and lower quality of life 6 to 12 months after hospital discharge. Although these findings need to be confirmed in larger studies, enhanced monitoring may be warranted for early identification and treatment of neurological and psychological symptoms.

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