tetano
Editor, Senior Moderator
J Neurol Sci
. 2024 Jan 3:457:122867.
doi: 10.1016/j.jns.2024.122867. Online ahead of print. Clinical characteristics of SARS-CoV-2-associated encephalopathy in children: Nationwide epidemiological study
Mariko Kasai[SUP] 1 [/SUP], Hiroshi Sakuma[SUP] 2 [/SUP], Yuichi Abe[SUP] 3 [/SUP], Ichiro Kuki[SUP] 4 [/SUP], Yoshihiro Maegaki[SUP] 5 [/SUP], Kei Murayama[SUP] 6 [/SUP], Yuka Murofushi[SUP] 7 [/SUP], Hiroaki Nagase[SUP] 8 [/SUP], Masahiro Nishiyama[SUP] 9 [/SUP], Akihisa Okumura[SUP] 10 [/SUP], Yasunari Sakai[SUP] 11 [/SUP], Hiroko Tada[SUP] 12 [/SUP], Masashi Mizuguchi[SUP] 13 [/SUP], Jun-Ichi Takanashi[SUP] 14 [/SUP]; Japanese Pediatric Neuro-COVID-19 Study Group
Collaborators, Affiliations
Objective: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sometimes triggers acute encephalopathy as a serious neurological complication in children. We previously reported the clinico-radiological findings of SARS-CoV-2-associated encephalopathy. The advent of the SARS-CoV-2 omicron variant led to a marked increase in pediatric patients with coronavirus disease 2019 (COVID-19); however, epidemiological changes with acute encephalopathy according to the emergence of SARS-CoV-2 have not yet been documented. Therefore, the present study investigated epidemiological differences in SARS-CoV-2-associated encephalopathy during the BA.1/BA.2 and BA.5 predominant periods and also between SARS-CoV-2-associated and non-SARS-CoV-2-associated encephalopathy.
Methods: We conducted a nationwide survey of SARS-CoV-2-associated encephalopathy in Japanese children between June and November 2022. We compared the present results during the BA.5 predominant period and previous findings during the BA.1/BA.2 predominant period. We also compared the clinico-radiological syndromes of encephalopathy between SARS-CoV-2-associated and non-SARS-CoV-2-associated encephalopathy.
Results: Although many patients with SARS-CoV-2-associated encephalopathy in the BA.5 predominant period had seizures as their initial symptoms, no significant differences were observed in the clinical features. Patients with SARS-CoV-2-associated encephalopathy had worse outcomes than those with non-SARS-CoV-2-associated encephalopathy (p-value = 0.003). Among 103 patients with SARS-CoV-2-associated encephalopathy, 14 (13.6%) had severe types of acute encephalopathy, namely, encephalopathy with acute fulminant cerebral edema (AFCE) and hemorrhagic shock and encephalopathy syndrome (HSES). Also, 28 (27.2%) patients with SARS-CoV-2-associated encephalopathy had poor outcome: severe neurological sequelae or death. Ninety-five patients (92.2%) were not vaccinated against SARS-CoV-2.
Conclusions: In SARS-CoV-2-associated encephalopathy, high percentages of AFCE and HSES can result in poor outcomes.
Keywords: Acute encephalopathy; COVID-19; Encephalopathy with acute fulminant cerebral edema; Hemorrhagic shock and encephalopathy syndrome; SARS-CoV-2.
. 2024 Jan 3:457:122867.
doi: 10.1016/j.jns.2024.122867. Online ahead of print. Clinical characteristics of SARS-CoV-2-associated encephalopathy in children: Nationwide epidemiological study
Mariko Kasai[SUP] 1 [/SUP], Hiroshi Sakuma[SUP] 2 [/SUP], Yuichi Abe[SUP] 3 [/SUP], Ichiro Kuki[SUP] 4 [/SUP], Yoshihiro Maegaki[SUP] 5 [/SUP], Kei Murayama[SUP] 6 [/SUP], Yuka Murofushi[SUP] 7 [/SUP], Hiroaki Nagase[SUP] 8 [/SUP], Masahiro Nishiyama[SUP] 9 [/SUP], Akihisa Okumura[SUP] 10 [/SUP], Yasunari Sakai[SUP] 11 [/SUP], Hiroko Tada[SUP] 12 [/SUP], Masashi Mizuguchi[SUP] 13 [/SUP], Jun-Ichi Takanashi[SUP] 14 [/SUP]; Japanese Pediatric Neuro-COVID-19 Study Group
Collaborators, Affiliations
- PMID: 38199023
- DOI: 10.1016/j.jns.2024.122867
Objective: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sometimes triggers acute encephalopathy as a serious neurological complication in children. We previously reported the clinico-radiological findings of SARS-CoV-2-associated encephalopathy. The advent of the SARS-CoV-2 omicron variant led to a marked increase in pediatric patients with coronavirus disease 2019 (COVID-19); however, epidemiological changes with acute encephalopathy according to the emergence of SARS-CoV-2 have not yet been documented. Therefore, the present study investigated epidemiological differences in SARS-CoV-2-associated encephalopathy during the BA.1/BA.2 and BA.5 predominant periods and also between SARS-CoV-2-associated and non-SARS-CoV-2-associated encephalopathy.
Methods: We conducted a nationwide survey of SARS-CoV-2-associated encephalopathy in Japanese children between June and November 2022. We compared the present results during the BA.5 predominant period and previous findings during the BA.1/BA.2 predominant period. We also compared the clinico-radiological syndromes of encephalopathy between SARS-CoV-2-associated and non-SARS-CoV-2-associated encephalopathy.
Results: Although many patients with SARS-CoV-2-associated encephalopathy in the BA.5 predominant period had seizures as their initial symptoms, no significant differences were observed in the clinical features. Patients with SARS-CoV-2-associated encephalopathy had worse outcomes than those with non-SARS-CoV-2-associated encephalopathy (p-value = 0.003). Among 103 patients with SARS-CoV-2-associated encephalopathy, 14 (13.6%) had severe types of acute encephalopathy, namely, encephalopathy with acute fulminant cerebral edema (AFCE) and hemorrhagic shock and encephalopathy syndrome (HSES). Also, 28 (27.2%) patients with SARS-CoV-2-associated encephalopathy had poor outcome: severe neurological sequelae or death. Ninety-five patients (92.2%) were not vaccinated against SARS-CoV-2.
Conclusions: In SARS-CoV-2-associated encephalopathy, high percentages of AFCE and HSES can result in poor outcomes.
Keywords: Acute encephalopathy; COVID-19; Encephalopathy with acute fulminant cerebral edema; Hemorrhagic shock and encephalopathy syndrome; SARS-CoV-2.