Objective: To analyze the clinical aspects, radiological features and evolution of COVID-19-associated movement disorders (MD) in children and adolescents.

Background: During the 5th wave of the SARS-COV2 pandemic, an outbreak of neurological manifestations in the pediatric population has been noted. Acute movement disorders represent a misunderstood facet of these manifestations.

Method: We conducted a prospective cohort study including patients who were hospitalized or consulted at the Department of Child and Adolescent Neurology of the National Institute of Neurology of Tunis during the period from January 1 to February 28, 2022, for acute MD during or after a recent (<21 days) SARS-COV2 infection. The infection was confirmed by RT-PCR, antigenic testing, or blood serology. We analyzed the epidemiological, clinical, radiological and evolutionary aspects of COVID-19-associated MD.

Results: We included 7 patients. The mean age was 8.6 years (2 months-17 years) and the sex ratio (M/F) was 3/4. The mean time of onset of MD was 5.7 days. The MD found were hyperkinetic in all cases. No cases of hypokinetic movements were found. The types of MD were in order of frequency: myoclonus (n=3), dystonia (n=3), tics (n=2). Brain imaging was abnormal in 2 cases. It showed acute necrotizing encephalopathy lesions in a 2-month-old infant and vasculitic lesions in a 7-year-old child with post-COVID-19 encephalitis. The electroencephalogram was abnormal in 2 cases. Symptomatic treatment with Piracetam and Clonazepam was given in one case. Immunotherapy was used in 2 patients. The evolution was spontaneously favorable in 5 patients. Two of them are still hospitalized.

Conclusion: MD are a rare aspect of COVID-19-associated neurologic manifestations particularly in children. Although no pathophysiological hypothesis has yet been confirmed, MD’s outbreak in pediatric population raises questions about the neurological tropism of emerging SARS-COV2 variants and the long-term sequelae of this disorders.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/acute-movement-disorders-a-new-aspect-of-sars-cov2-infection-in-children/