Long-term central nervous system (CNS) consequences of COVID-19 in children

ABSTRACT

Introduction

Neurological/neuropsychiatric symptoms are commonly reported by children/young people with long COVID, especially headache, fatigue, cognitive deficits, anosmia and ageusia, dizziness, mood symptoms, and sleep problems. However, reported prevalence estimates are highly variable due to study heterogeneity and often small sample size; most studies only considered short-term follow-ups; and, apart from mood and sleep problems, neuropsychiatric conditions have received less attention. Considering the potential debilitating effects of neurological/neuropsychiatric conditions, a comprehensive review of the topic is timely, and needed to support clinical recognition as well as to set the direction for future research.

Areas covered

The authors discuss neurological/neuropsychiatric manifestations of long COVID in pediatric populations, with a focus on prevalence, associated demographic characteristics, and potential pathogenetic mechanisms.

Expert opinion

Children/young people may develop persistent neurological/neuropsychiatric symptoms following acute SARS‐CoV‐2 infection, which may affect daily functioning and well-being. Studies in larger samples with longer follow-ups are needed to clarify prevalence and symptom duration; as well as less investigated risk factors, including genetic predisposition, ethnicity, and comorbidities. Controlled studies may help separate infection-related direct effects from pandemic-related psychosocial stressors. Clarifying pathogenetic mechanisms is paramount to develop more targeted and effective treatments; whilst screening programs and psychoeducation may enhance early recognition.

KEYWORDS:

• children
• adolescents
• COVID-19
• Long COVID
• neurological
• neuropsychiatric

Article highlights

• Children and young people tend to remain asymptomatic or only experience mild symptoms of acute COVID-19 but can develop persistent symptoms (long COVID).

• Symptoms of long COVID include neurological and neuropsychiatric manifestations, most often headache, fatigue, cognitive deficits, anosmia and ageusia, dizziness, mood symptoms and sleep problems.

• Studies to date have provided inconsistent data on prevalence and symptom duration; as many were limited by the small sample size, lack of comparative data, and short follow-up.

• Infection-related mechanisms, such as chronic systemic inflammation, oxidative stress, and immune-mediated processes are considered to play a prominent role in the development of neurological symptoms, whilst pandemic-related factors (e.g. concerns about exposure and impact of restrictions) may be more relevant for neuropsychiatric conditions (e.g. anxiety and sleep problems).

• Further studies are needed to clarify pathogenetic mechanisms, differences with adults, and duration/course of more persistent symptoms.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This manuscript was not funded.