Pediatric de novo movement disorders and ataxia in the context of SARS-CoV-2

Journal of Neurology · 14 authors, 8 centres

AI SUMMARY

FIDELITY 100%

This summary was generated by AI from a single paper. It has not been reviewed by a clinician and is not clinical advice. Verify against the source before acting on it.

AGENT 01 · STRUCTURED SUMMARY

TRACE TO SOURCE

“

TL;DR

The central result is that most children required immunosuppressive treatment, often with steroids, and about one-third recovered only partially.

Full summary

939 CHARS

The study presents a case report of a 10-year-old girl with hemichorea after SARS-CoV-2 infection and a scoping review of 32 additional children. The case patient had intrathecal antibodies binding to unknown antigens in murine basal ganglia and recovered completely with immunosuppression. The review found that 79% of children had ataxia and 21% had hypo-/hyperkinetic movement disorders, mostly chorea. Etiology was often suspected to be autoimmune. Treatment was needed in 79% of cases, with steroids, intravenous immunoglobulin (IVIG), or combination therapy. Overall, 57% fully recovered, 29% partially recovered, and 14% spontaneously recovered. Limitations include the small, heterogeneous sample from a scoping review and short median follow-up of two months. The findings suggest SARS-CoV-2 can trigger autoimmune-related movement disorders in children, with immunosuppression being beneficial but not guaranteeing full recovery.

STUDY TYPE

other

SPECIALTY

pediatrics

SUMMARISED BY

AI pipeline

FIDELITY CHECK

100% · A

ORIGINAL PAPER

PMC10511612

Pediatric de novo movement disorders and ataxia in the context of SARS-CoV-2

Journal of Neurology

READ THE FULL PAPER

ABSTRACT

Abstract Objective In the fourth year of the COVID-19 pandemic, mortality rates decreased, but the risk of neuropsychiatric disorders remained the same, with a prevalence of 3.8% of pediatric cases, including movement disorders (MD) and ataxia. Methods In this study, we report on a 10-year-old girl with hemichorea after SARS-CoV-2 infection and immunostained murine brain with patient CSF to identify intrathecal antibodies. Additionally, we conducted a scoping review of children with MD and ataxia after SARS-CoV-2 infection. Results We detected antibodies in the patient's CSF binding unknown antigens in murine basal ganglia. The child received immunosuppression and recovered completely. In a scoping review, we identified further 32 children with de novo MD or ataxia after COVID-19. While in a minority of cases, MD or ataxia were a symptom of known clinical entities (e.g. ADEM, Sydenham's chorea), in most children, the etiology was suspected to be of autoimmune origin without further assigned diagnosis. (i) Children either presented with ataxia (79%), but different from the well-known postinfectious acute cerebellar ataxia (older age, less favorable outcome, or (ii) had hypo-/hyperkinetic MD (21%), which were choreatic in most cases. Besides 14% of spontaneous recovery, immunosuppression was necessary in 79%. Approximately one third of children only partially recovered. Conclusions Infection with SARS-CoV-2 can trigger de novo MD in children. Most patients showed COVID-19-associated-ataxia and fewer-chorea. Our data suggest that patients benefit from immunosuppression, especially steroids. Despite treatment, one third of patients recovered only partially, which makes up an increasing cohort with neurological sequelae. Supplementary Information The online version contains supplementary material available at 10.1007/s00415-023-11853-5. Keywords: Pediatric movement disorder, Acute cerebellar ataxia, Acute cerebellitis, COVID-19, Neuroimmunology, Pediatric neurology

CITATION EXPORT

Nina-Maria Wilpert, Ana Luísa de Almeida Marcelino, Ellen Knierim et al.. Pediatric de novo movement disorders and ataxia in the context of SARS-CoV-2. Journal of Neurology. (2023). https://doi.org/10.1007/s00415-023-11853-5

AUTHORS

14 · 8 CENTRES

Nina-Maria Wilpert, Ana Luísa de Almeida Marcelino, Ellen Knierim, Pasquale Incoronato, Elisa Sanchez-Sendin, Olga Staudacher, Anne Drenckhahn, Petra Bittigau, Jakob Kreye, Harald Prüss, Markus Schuelke, Andrea A Kühn, Angela M Kaindl, Marc Nikolaus

1Department of Neuropediatrics, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany
2Center for Chronically Sick Children, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin, Germany
3Department of Neurology with Experimental Neurology, Movement Disorders and Neuromodulation Unit, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin, Germany
4German Center for Neurodegenerative Diseases (DZNE), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin, Germany
5Department of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin, Germany
6Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin, Germany
7NeuroCure Clinical Research Center, Berlin, Germany
8Department of Immunology, Labor Berlin GmbH, Berlin, Germany