Department 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.
Center 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.
J Neurol. 2023 Oct;270(10):4593-4607. doi: 10.1007/s00415-023-11853-5. Epub 2023 Jul 29.
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.
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.
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.
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.
在 COVID-19 大流行的第四年，死亡率有所下降，但神经精神障碍的风险仍然相同，儿科病例中有 3.8%存在运动障碍（MD）和共济失调。
在本研究中，我们报告了一例 10 岁女孩在 SARS-CoV-2 感染后出现半身舞蹈症，并使用患者的脑脊液对鼠脑进行免疫染色，以鉴定鞘内抗体。此外，我们对 SARS-CoV-2 感染后出现 MD 和共济失调的儿童进行了范围综述。
我们在患者的脑脊液中检测到了结合鼠基底节中未知抗原的抗体。患儿接受了免疫抑制治疗并完全康复。在范围综述中，我们又发现了 32 例 COVID-19 后新发 MD 或共济失调的儿童。虽然在少数情况下，MD 或共济失调是已知临床实体的症状（例如 ADEM、风湿性舞蹈病），但在大多数儿童中，病因被怀疑是自身免疫性的，而没有进一步的明确诊断。（i）儿童要么表现为共济失调（79%），但与已知的感染后急性小脑共济失调不同（年龄较大，预后较差，或（ii）存在低/高运动 MD（21%），其中大多数为舞蹈症。除 14%自发恢复外，79%需要免疫抑制治疗。大约三分之一的儿童仅部分恢复。
SARS-CoV-2 感染可导致儿童新发 MD。大多数患者表现为 COVID-19 相关共济失调和较少的舞蹈症。我们的数据表明，患者受益于免疫抑制治疗，尤其是类固醇。尽管进行了治疗，但仍有三分之一的患者仅部分恢复，这使得患有神经系统后遗症的患者人数不断增加。
