vice-dean Children's hospital of Fudan university Shanghai, Shanghai, China (People's Republic)
Background: Children with COVID-19 account for about 10% of all COVID-19 cases and have a less severe illness compared with adult patients. The most common symptoms are fever and cough and other symptoms include fatigue, myalgia, nausea and vomiting, abdominal pain, and diarrhea. Most of the symptoms resolve within one week. Neurological symptoms varied between new onset seizures, anosmia, ageusia and focal arteriopathy in many studies. During the Omicron strain epidemic, the number of COVID-19 infections, hospitalization and neurological symptoms were higher than other SARS‑CoV‑2 variant outbreaks. Encephalitis and death have been reported in COVID-19 infected children in Hong Kong, Japan, Taiwan and other regions9. Seizure in children with COVID-19 may be caused by viral encephalitis and brain injury. Objective: To explore the clinical characteristics and prognosis of febrile seizure in children with COVID-19. Design/Methods: This study is a single-center retrospective cohort study. The cases included febrile seizures in children with COVID-19 admitted to the Renji Hospital from April 7th, 2022 to June 2nd, 2022. We compared children with and without febrile seizures in their clinical characteristics such as sex, age, symptoms, seizure manifestation, COVID-19 severity, and SARS‑CoV‑2 nucleic acid test results. The children with febrile seizures were followed up by telephone and outpatient service about one month after the nucleic acid turned negative and discharged from the hospital. Results: A total of 585 cases of children with COVID-19 were included in the analysis. There were 15 children (1.8%) with febrile seizures, age from six months to three years old, nine boys (60.0%) and six girls (40.0%). The manifestations of febrile seizures were all generalized tonic-clonic seizures. The median nucleic acid negative conversion time was 11 (IQR:10.75,13) days. Our first comparison involved comparing children without underlying diseases; there was no significant difference in sex, COVID-19 severity, and clinical manifestations, but there was an age difference (2 vs.1.3, P=0.047). There was no difference in SARS‑CoV‑2 nucleic acid negative time between the two groups (11d vs.13d, P=0.128). Two children had new clinical manifestations during the follow-up, but their EEG and MRI were normal.
Conclusion(s): Febrile seizure may be children's primary neurological manifestation of COVID-19. It may occur in children with no history of epilepsy and is not associated with severe illness. The long-term neurological outcomes of these children should be followed up.
