Clinical characteristics of SARS-CoV-2-associated encephalopathy in children: Nationwide epidemiological study

• DOI: 10.1016/j.jns.2024.122867
• Publication Date: 2024-01-03T15:21:43Z
• Authors: Mariko Kasai; Hiroshi Sakuma; Yuichi Abe; Ichiro Kuki; Yoshihiro Maegaki; Kei Murayama; Yuka Murofushi; Hiroaki Nagase; Masahiro Nishiyama; Akihisa Okumura; Yasunari Sakai; Hiroko Tada; Masashi Mizuguchi; Jun-ichi Takanashi; Satoshi Akamine; Pin Fee Chong; Tatsuya Ema; Sayaka Enomoto; Ryohei Fukatsu; Yoshiyuki Hanaoka; Ayuko Igarashi; Tae Ikeda; Kouhei Ishida; Nobutsune Ishikawa; Shinji Itamura; Hideyuki Iwayama; Nanako Kawata; Go Kawano; Kenjiro Kikuchi; Osamu Kobayashi; Hidehito Kondo; Seigo Korematsu; Tsuyoshi Matsuoka; Yuki Minamisawa; Osamu Mitani; Kanako Mizuma; Tatsuo Mori; Shinichiro Morichi; Yoko Moriyama; Mitsuo Motobayashi; Hirotaka Motoi; Kazuhiro Muramatsu; Kazuyuki Nakamura; Tomoyuki Nakazawa; Yutaka Negishi; Yuka Nishizawa; Hiroshi Okada; Kazuo Okanari; Keisuke Oki; Yoshinori Okumura; Taku Omata; Saki Saeki; Fumikazu Sano; Kentaro Sano; Tatsuharu Sato; Takashi Shiihara; Konomi Shimoda; Motomasa Suzuki; Ryuta Tanaka; Chiho Tokorodani; Mitsugu Uematsu; Hiroyuki Yamada; Naohiro Yamamoto; Tatsuya Yamamoto; Haruna Yokoyama

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.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.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.In SARS-CoV-2-associated encephalopathy, high percentages of AFCE and HSES can result in poor outcomes.