Pediatric de novo movement disorders and ataxia in the context of SARS-CoV-2, 2023, Wilpert et al.

Pediatric de novo movement disorders and ataxia in the context of SARS-CoV-2
Wilpert, Nina-Maria; de Almeida Marcelino, Ana Luísa; Knierim, Ellen; Incoronato, Pasquale; Sanchez-Sendin, Elisa; Staudacher, Olga; Drenckhahn, Anne; Bittigau, Petra; Kreye, Jakob; Prüss, Harald; Schuelke, Markus; Kühn, Andrea A.; Kaindl, Angela M.; Nikolaus, Marc

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.

Link | PDF (Journal of Neurology)

 

Fortunately, this child was seen in Berlin not Edinburgh.

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Refs —
Functional Movement Disorders during COVID-19: Psychological Distress, Affective Temperament and Emotional Dysregulation (2023, Journal of Personalized Medicine)
Increased Incidence of Functional Psychogenic Movement Disorders in Children and Adults Amid the COVID-19 Pandemic: A Cross-sectional Study (2021, Neurology: Clinical Practice)
COVID-19 related increase in childhood tics and tic-like attacks (2021, Archives of Disease in Childhood)
Rapid Onset Functional Tic-Like Behaviors in Young Females During the COVID-19 Pandemic (2021, Movement Disorders)

 

Harald Prüss and his group also do some associated research on autoantibodies in the CSF and associations to Long-Covid. They published https://www.sciencedirect.com/science/article/pii/S0889159123000065?via=ihub and are currently doing a follow-up of this work.

 

Most of these would get FND on their chart.