Neurologic Complications in Children with Seizures and Respiratory Illness: A Comparison between SARS-CoV-2 and Other Respiratory Viruses

Background: Children with SARS-CoV-2 infection commonly experience neurological symptoms but limited data is available on neurological symptoms associated with other respiratory infections. We compare rates of neurological symptoms in children hospitalized with seizures and respiratory infections, including SARS-CoV-2, influenza, and endemic coronaviruses.Methods: Retrospective cohort study was performed on children admitted for seizures and positive respiratory infection PCR for SARS-CoV-2, Coronavirus NL63, Coronavirus OC34, influenza (A and B), adenovirus, Mycoplasma pneumoniae, and parainfluenza 3 or 4. Primary outcomes were rates of neurological diagnoses and mortality.Results: A total of 883 children were included. Mortality rates were 0.6% in influenza A to 4.9% in parainfluenza 4, with 0% in M. pneumoniae. Encephalopathy was noted in 5-15.6%. Strokes were seen in all infections except for coronavirus OC43 and M. pneumoniae, with 4.9% in parainfluenza 4 and 5.9% in SARS-CoV-2. The most common brain MRI abnormality was diffusion restriction related to stroke, meningitis, or seizures. Differences between SARS-CoV-2 and OC were observed in stroke (5.9% vs. 0.5%, p-value=0.019). Abnormal MRI rates were lower in SARS-CoV-2, compared to OC patients (57% versus 82%) with a medium to large effect size (standard mean difference) of 0.55.However, rates of stroke, encephalopathy, hypoxic-ischemic encephalopathy, and meningoencephalitis were similar between SARS-CoV-2 and influenza cohorts. Conclusions: In hospitalized children with seizures, higher rates of stroke were observed in SARS-CoV-2 versus OC. Similar rates of neurological symptoms were observed in SARS-CoV-2 versus influenza patients. Strokes can occur in children with these viral infections, particularly SARS-CoV-2.