Association of SARS-CoV-2 infection with neurological impairments in pediatric population: A systematic review

Angela T H Kwan; Jacob S Portnoff; Khaled Al-Kassimi; Gurkaran Singh; Mehrshad Hanafimosalman; Marija Tesla; Nima Gharibi; Tiffany Ni; Ziji Guo; Davaine J N Sonfack; Julia Martyniuk; Saman Arfaie; Mohammad Sadegh Mashayekhi; Mohammad Mofatteh; Richie Jeremian; Kevin Ho; Luis Rafael Moscote-Salazar; Ángel Lee; Muhammad Youshay Jawad; Felicia Ceban; Kayla M Teopiz; Rodrigo B Mansur; Roger Ho; Joshua D Rosenblat; Bing Cao; Taeho Greg Rhee; Roger S McIntyre

doi:10.1016/j.jpsychires.2023.12.005

Association of SARS-CoV-2 infection with neurological impairments in pediatric population: A systematic review

J Psychiatr Res. 2024 Feb:170:90-110. doi: 10.1016/j.jpsychires.2023.12.005. Epub 2023 Dec 11.

Authors

Angela T H Kwan¹, Jacob S Portnoff², Khaled Al-Kassimi³, Gurkaran Singh⁴, Mehrshad Hanafimosalman⁵, Marija Tesla⁶, Nima Gharibi⁷, Tiffany Ni⁸, Ziji Guo⁹, Davaine J N Sonfack¹⁰, Julia Martyniuk¹¹, Saman Arfaie¹², Mohammad Sadegh Mashayekhi¹³, Mohammad Mofatteh¹⁴, Richie Jeremian¹⁵, Kevin Ho¹⁶, Luis Rafael Moscote-Salazar¹⁷, Ángel Lee¹⁸, Muhammad Youshay Jawad¹⁹, Felicia Ceban²⁰, Kayla M Teopiz²¹, Rodrigo B Mansur²², Roger Ho²³, Joshua D Rosenblat²⁴, Bing Cao²⁵, Taeho Greg Rhee²⁶, Roger S McIntyre²⁷

Affiliations

¹ Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada; Brain and Cognition Discovery Foundation, Toronto, ON, Canada; Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada. Electronic address: angela.kwan@mail.utoronto.ca.
² Faculty of Medicine, The University of Queensland, Brisbane, Qld, Australia. Electronic address: j.portnoff@uq.net.au.
³ Political Science and International Relations, American University in the Emirates, United Arab Emirates. Electronic address: khaled.alkassimi@aue.ae.
⁴ Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada. Electronic address: gurkaran.singh@ubc.ca.
⁵ Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada. Electronic address: mehrshad.hanafimosalman@mail.mcgill.ca.
⁶ Department of Criminology & Socio-Legal Studies and Political Science, University of Toronto, Toronto, ON, Canada. Electronic address: maria.tesla@mail.utoronto.ca.
⁷ Department of Medicine, Saint James School of Medicine Anguilla, The Valley, Anguilla. Electronic address: nima.gharibi@mail.utoronto.ca.
⁸ Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada. Electronic address: tiffany.ni@mail.utoronto.ca.
⁹ Brain and Cognition Discovery Foundation, Toronto, ON, Canada; Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada. Electronic address: ziji.guo@mail.utoronto.ca.
¹⁰ Faculty of Medicine, Laval University, Québec, QC, Canada. Electronic address: davaine-joel.ndongo-sonfack.1@ulaval.ca.
¹¹ Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada. Electronic address: julia.martyniuk@utoronto.ca.
¹² Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada; Department of Molecular and Cell Biology, University of California Berkeley, Berkeley, CA, United States of America. Electronic address: saman.arfaie@berkeley.edu.
¹³ Faculty of Medicine, The University of Queensland, Brisbane, Qld, Australia. Electronic address: sadegh@student.ubc.ca.
¹⁴ School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, United Kingdom. Electronic address: mohammad.mofatteh@gmail.com.
¹⁵ Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada. Electronic address: richie.jeremian@mail.mcgill.ca.
¹⁶ Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada. Electronic address: k12ho@ryerson.ca.
¹⁷ Department of Neurosurgery, University of Cartagena, Cartagena de Indias, Colombia. Electronic address: rafaelmoscote21@gmail.com.
¹⁸ Department of Neurosurgery, Comprehensive Stroke Unit, Hospital Ángeles del Pedregal, Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán, Mexico City, 14000, Mexico. Electronic address: dr_angel_lee@yahoo.de.
¹⁹ Brain and Cognition Discovery Foundation, Toronto, ON, Canada; Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada. Electronic address: youshayjwd@gmail.com.
²⁰ Brain and Cognition Discovery Foundation, Toronto, ON, Canada; Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada. Electronic address: felicia.ceban@mail.utoronto.ca.
²¹ Brain and Cognition Discovery Foundation, Toronto, ON, Canada; Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada. Electronic address: kayla.teopiz@mail.utoronto.ca.
²² Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada. Electronic address: rodrigo.mansur@uhn.ca.
²³ Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Queenstown, Singapore; Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, Queenstown, Singapore. Electronic address: pcmrhcm@nus.edu.sg.
²⁴ Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada. Electronic address: joshua.rosenblat@uhn.ca.
²⁵ Key Laboratory of Cognition and Personality, Faculty of Psychology, Ministry of Education, Southwest University, Chongqing, China. Electronic address: bingcao@swu.edu.cn.
²⁶ Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, United States of America; VA New England Mental Illness, Research, Education and Clinical Center (MIRECC), VA Connecticut Healthcare System, Bedford, United States of America; Department of Public Health Sciences, School of Medicine, University of Connecticut, Storrs, CT, United States of America. Electronic address: rhee@uchc.edu.
²⁷ Brain and Cognition Discovery Foundation, Toronto, ON, Canada; Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada. Electronic address: roger.mcintyre@bcdf.org.

PMID: 38134724
DOI: 10.1016/j.jpsychires.2023.12.005

Abstract

Neurological manifestations have been widely reported in adults with COVID-19, yet the extent of involvement among the pediatric population is currently poorly characterized. The objective of our systematic review is to evaluate the association of SARS-CoV-2 infection with neurological symptoms and neuroimaging manifestations in the pediatric population. A literature search of Cochrane Library; EBSCO CINAHL; Global Index Medicus; OVID AMED, Embase, Medline, PsychINFO; and Scopus was conducted in accordance with the Peer Review of Electronic Search Strategies form (October 1, 2019 to March 15, 2022). Studies were included if they reported (1) COVID-19-associated neurological symptoms and neuroimaging manifestations in individuals aged <18 years with a confirmed, first SARS-CoV-2 infection and were (2) peer-reviewed. Full-text reviews of 222 retrieved articles were performed, along with subsequent reference searches. A total of 843 no-duplicate records were retrieved. Of the 19 identified studies, there were ten retrospective observational studies, seven case series, one case report, and one prospective cohort study. A total of 6985 individuals were included, where 12.8% (n = 892) of hospitalized patients experienced neurocognitive impairments which includes: 1) neurological symptoms (n = 294 of 892, 33.0%), 2) neurological syndromes and neuroimaging abnormalities (n = 223 of 892, 25.0%), and 3) other phenomena (n = 233 of 892, 26.1%). Based on pediatric-specific cohorts, children experienced more drowsiness (7.3% vs. 1.3%) and muscle weakness (7.3% vs. 6.3%) as opposed to adolescents. Agitation or irritability was observed more in children (7.3%) than infants (1.3%). Our findings revealed a high prevalence of immune-mediated patterns of disease among COVID-19 positive pediatric patients with neurocognitive abnormalities.

Keywords: COVID-19; Cognition fatigue; MIS-C; Neuroimaging manifestations; Neurological symptoms; Pediatrics.

Publication types

Systematic Review
Case Reports
Review

MeSH terms

Adolescent
Adult
COVID-19* / complications
Child
Humans
Infant
Prevalence
Prospective Studies
Retrospective Studies
SARS-CoV-2