Department of Neurology, Boston Children's Hospital, Boston, Massachusetts.
Department of Neurology, Harvard Medical School, Boston, Massachusetts.
JAMA Netw Open. 2023 Jul 3;6(7):e2324369. doi: 10.1001/jamanetworkopen.2023.24369.
Acute neurological involvement occurs in some patients with multisystem inflammatory syndrome in children (MIS-C), but few data report neurological and psychological sequelae, and no investigations include direct assessments of cognitive function 6 to 12 months after discharge.
To characterize neurological, psychological, and quality of life sequelae after MIS-C.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional cohort study was conducted in the US and Canada. Participants included children with MIS-C diagnosed from November 2020 through November 2021, 6 to 12 months after hospital discharge, and their sibling or community controls, when available. Data analysis was performed from August 2022 to May 2023.
Diagnosis of MIS-C.
A central study site remotely administered a onetime neurological examination and in-depth neuropsychological assessment including measures of cognition, behavior, quality of life, and daily function. Generalized estimating equations, accounting for matching, assessed for group differences.
Sixty-four patients with MIS-C (mean [SD] age, 11.5 [3.9] years; 20 girls [31%]) and 44 control participants (mean [SD] age, 12.6 [3.7] years; 20 girls [45%]) were enrolled. The MIS-C group exhibited abnormalities on neurological examination more frequently than controls (15 of 61 children [25%] vs 3 of 43 children [7%]; odds ratio, 4.7; 95% CI, 1.3-16.7). Although the 2 groups performed similarly on most cognitive measures, the MIS-C group scored lower on the National Institutes of Health Cognition Toolbox List Sort Working Memory Test, a measure of executive functioning (mean [SD] scores, 96.1 [14.3] vs 103.1 [10.5]). Parents reported worse psychological outcomes in cases compared with controls, particularly higher scores for depression symptoms (mean [SD] scores, 52.6 [13.1] vs 47.8 [9.4]) and somatization (mean [SD] scores, 55.5 [15.5] vs 47.0 [7.6]). Self-reported (mean [SD] scores, 79.6 [13.1] vs 85.5 [12.3]) and parent-reported (mean [SD] scores, 80.3 [15.5] vs 88.6 [13.0]) quality of life scores were also lower in cases than controls.
In this cohort study, compared with contemporaneous sibling or community controls, patients with MIS-C had more abnormal neurologic examinations, worse working memory scores, more somatization and depression symptoms, and lower quality of life 6 to 12 months after hospital discharge. Although these findings need to be confirmed in larger studies, enhanced monitoring may be warranted for early identification and treatment of neurological and psychological symptoms.
急性神经系统受累发生在一些儿童多系统炎症综合征（MIS-C）患者中，但很少有数据报告神经系统和心理后遗症，也没有研究包括出院后 6 至 12 个月对认知功能的直接评估。
描述 MIS-C 后的神经、心理和生活质量后遗症。
设计、地点和参与者：这是一项在美国和加拿大进行的横断面队列研究。参与者包括 2020 年 11 月至 2021 年 11 月期间诊断为 MIS-C 的儿童，出院后 6 至 12 个月，并在可能的情况下纳入其兄弟姐妹或社区对照者。数据分析于 2022 年 8 月至 2023 年 5 月进行。
MIS-C 的诊断。
一个中心研究站点远程进行了一次性神经检查和深入的神经心理学评估，包括认知、行为、生活质量和日常功能的测量。广义估计方程，考虑匹配，评估组间差异。
64 名 MIS-C 患儿（平均[SD]年龄，11.5[3.9]岁；20 名女孩[31%]）和 44 名对照参与者（平均[SD]年龄，12.6[3.7]岁；20 名女孩[45%]）入组。与对照组相比，MIS-C 组更频繁地出现神经系统检查异常（61 名儿童中有 15 名[25%] vs 43 名儿童中有 3 名[7%]；优势比，4.7；95%CI，1.3-16.7）。尽管两组在大多数认知测量上表现相似，但 MIS-C 组在国家卫生研究院认知工具包列表排序工作记忆测试中的得分较低，这是一种执行功能的测量（平均[SD]分数，96.1[14.3] vs 103.1[10.5]）。与对照组相比，患儿父母报告的心理结局更差，尤其是抑郁症状评分较高（平均[SD]分数，52.6[13.1] vs 47.8[9.4]）和躯体化症状评分较高（平均[SD]分数，55.5[15.5] vs 47.0[7.6]）。自我报告（平均[SD]分数，79.6[13.1] vs 85.5[12.3]）和家长报告（平均[SD]分数，80.3[15.5] vs 88.6[13.0]）的生活质量评分也低于对照组。
在这项队列研究中，与同期的兄弟姐妹或社区对照者相比，MIS-C 患儿的神经系统检查异常更多，工作记忆评分更差，躯体化和抑郁症状更多，出院后 6 至 12 个月生活质量更低。尽管这些发现需要在更大的研究中得到证实，但可能需要加强监测，以便早期发现和治疗神经和心理症状。
