Persistent neurological sequelae in children and adolescents after SARS-CoV-2: a scoping review

Salma Zouari Mallouli^{1

2}, Daniel Munblit^{3

4}, Ekaterina Iakovleva⁴, Andrea Sylvia Winkler^{5

6

7

8}, Arianna Fornari⁹, Raimund Helbok^{10

11}, Walter Struhal^{12

13}, Simone Beretta^{14

15}, Wouter De Groote¹⁶, Chiara Curatoli¹⁷, Martina Lanza⁹, Fink Ericka^{18

19}, Lucia Crivelli²⁰, Giorgia Giussani²¹, Mohammad Wasay²², Olfa Chakroun Walha²³, Faiza Safi²⁴, Matilde Leonardi²⁵, Ricardo Allegri^{20

26}, Alla Guekht²⁷, Chahnez Charfi Triki^{28

29}

Affiliations

¹ Child Neurology Department at Hedi Chaker, Sfax University Hospital, Sfax, Tunisia. mallouli.salma26@gmail.com.
² Research Laboratory LR19ES15, University of Sfax, Sfax, Tunisia. mallouli.salma26@gmail.com.
³ Division of Care in Long Term Conditions, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK.
⁴ Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.
⁵ Center for Global Health, School of Medicine and Health, Technical University of Munich, Munich, Germany.
⁶ Department of Neurology, TUM University Hospital, Technical University Munich (TUM), Munich, Germany.
⁷ Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway.
⁸ Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.
⁹ Public Health, and Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy.
¹⁰ Department of Neurology, Kepler University Hospital, Johannes Kepler University Linz, Linz, Austria.
¹¹ Clinical Research Institute for Neuroscience, Johannes Kepler University Linz, Linz, Austria.
¹² Karl Landsteiner University of Health Sciences, Krems, Austria.
¹³ Division of Neurology, University Hospital Tulln, Tulln, Austria.
¹⁴ Department of Neurology and Stroke Unit, Fondazione IRCCS San Gerardo Dei Tintori, Monza, Italy.
¹⁵ Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.
¹⁶ Department of Noncommunicable Diseases, Disability and Rehabilitation, World Health Organization, Geneva, Switzerland.
¹⁷ Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.
¹⁸ Department of Critical Care Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.
¹⁹ Safar Center for Resuscitation Research, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
²⁰ Department of Cognitive Neurology, Fleni, Buenos Aires, Argentina.
²¹ Department of Neuroscience, Istituto Di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy.
²² Department of Neurology, Aga Khan University, Karachi, Pakistan.
²³ Emergency Department, Habib Bourguiba Sfax University Hospital, University of Sfax, Sfax, Tunisia.
²⁴ Department of Pediatrics, Hedi Chaker Sfax University Hospital, Faculty of Medicine, University of Sfax, Sfax, Tunisia.
²⁵ Neurology, Public Health, Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.
²⁶ Department of Neurosciences, Universidad de la Costa (CUC), Colombia, Barranquilla, Colombia.
²⁷ Moscow Research and Clinical Center for Neuropsychiatry, Moscow, Russia.
²⁸ Child Neurology Department at Hedi Chaker, Sfax University Hospital, Sfax, Tunisia.
²⁹ Research Laboratory LR19ES15, University of Sfax, Sfax, Tunisia.

PMID: 41171518
DOI: 10.1007/s15010-025-02669-8

Review

Persistent neurological sequelae in children and adolescents after SARS-CoV-2: a scoping review

Salma Zouari Mallouli et al. Infection. 2025.

. 2025 Oct 31.

doi: 10.1007/s15010-025-02669-8. Online ahead of print.

Authors

Affiliations

¹ Child Neurology Department at Hedi Chaker, Sfax University Hospital, Sfax, Tunisia. mallouli.salma26@gmail.com.
² Research Laboratory LR19ES15, University of Sfax, Sfax, Tunisia. mallouli.salma26@gmail.com.
³ Division of Care in Long Term Conditions, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK.
⁴ Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.
⁵ Center for Global Health, School of Medicine and Health, Technical University of Munich, Munich, Germany.
⁶ Department of Neurology, TUM University Hospital, Technical University Munich (TUM), Munich, Germany.
⁷ Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway.
⁸ Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.
⁹ Public Health, and Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy.
¹⁰ Department of Neurology, Kepler University Hospital, Johannes Kepler University Linz, Linz, Austria.
¹¹ Clinical Research Institute for Neuroscience, Johannes Kepler University Linz, Linz, Austria.
¹² Karl Landsteiner University of Health Sciences, Krems, Austria.
¹³ Division of Neurology, University Hospital Tulln, Tulln, Austria.
¹⁴ Department of Neurology and Stroke Unit, Fondazione IRCCS San Gerardo Dei Tintori, Monza, Italy.
¹⁵ Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.
¹⁶ Department of Noncommunicable Diseases, Disability and Rehabilitation, World Health Organization, Geneva, Switzerland.
¹⁷ Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.
¹⁸ Department of Critical Care Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.
¹⁹ Safar Center for Resuscitation Research, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
²⁰ Department of Cognitive Neurology, Fleni, Buenos Aires, Argentina.
²¹ Department of Neuroscience, Istituto Di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy.
²² Department of Neurology, Aga Khan University, Karachi, Pakistan.
²³ Emergency Department, Habib Bourguiba Sfax University Hospital, University of Sfax, Sfax, Tunisia.
²⁴ Department of Pediatrics, Hedi Chaker Sfax University Hospital, Faculty of Medicine, University of Sfax, Sfax, Tunisia.
²⁵ Neurology, Public Health, Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.
²⁶ Department of Neurosciences, Universidad de la Costa (CUC), Colombia, Barranquilla, Colombia.
²⁷ Moscow Research and Clinical Center for Neuropsychiatry, Moscow, Russia.
²⁸ Child Neurology Department at Hedi Chaker, Sfax University Hospital, Sfax, Tunisia.
²⁹ Research Laboratory LR19ES15, University of Sfax, Sfax, Tunisia.

PMID: 41171518
DOI: 10.1007/s15010-025-02669-8

Abstract

Objectives: For the past five years, COVID-19 has not only been a priority for health planning but also a hotspot for clinical research. Yet, the weight of the worldwide COVID-19 pandemic arises from the critical phase consequences due to the onset of acute disease, associated containment measures, and documented ongoing disabling symptoms. Investigating the global longitudinal effects on children and adolescents will inform future health directives tailored to this population's needs. This review aimed to report the spectrum of persistent neurological sequelae in children and adolescents following SARS-CoV-2 infection.

Methods: Hence, we conducted a scoping review following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). We included the peer-reviewed articles from PubMed, Google Scholar, Web of Science, Cochrane Library, and WHO COVID database to identify relevant literature on long-COVID-19 neurological signs/symptoms among children and adolescents. The search covered the period between September 2020 and September 2024.

Results: The results of our analysis of 33 studies found long-COVID-19-related neurological signs/symptoms were predominantly: pain and sensory problems (N = 74,612/91,543; 81.5%), followed by sleep disturbances (N = 14,630/91,543; 15.9%), and cognitive difficulties (N = 2274/91,543; 2.4%). The global prevalence of long COVID-19 neurological signs/symptoms was estimated between 0.4% (20/5032; 95% CI = 2.1-3%) and 34% (27/79) based on data obtained through online questionnaire; while it varied between 1.8% (4/215) and 83.14% (74/89; 95%CI = - 0.12; 0.30) based on patient assessment. Long-COVID-19-related neurological signs/symptoms were more common in the 11-16 age group. Children with immunocompetent profiles were at higher risk of developing long-COVID-19-related neurological signs/symptoms.

Conclusion: Our results demonstrate a considerable burden of COVID-19-related persistent neurological signs/symptoms in children and adolescents, which should be taken into consideration in healthcare decision-making.

Keywords: Long COVID-19; Neurological sequelae; Pediatric; SARS-CoV-2 infection.

PubMed Disclaimer

Conflict of interest statement

Declarations. Conflict of interest: The authors declare no competing interests.

References

1. Alcamo AM, McGuire JL, Kanthimathinathan HK, et al. Worldwide epidemiology of neuro-coronavirus disease in children: lessons for the next pandemic. Curr Opin Pediatr. 2021;33:580–90. https://doi.org/10.1097/MOP.0000000000001069 . - DOI - PubMed - PMC
1. Pazukhina E, Andreeva M, Spiridonova E, et al. Prevalence and risk factors of post-COVID-19 condition in adults and children at 6 and 12 months after hospital discharge: a prospective, cohort study in Moscow (StopCOVID). BMC Med. 2022;20:244. https://doi.org/10.1186/s12916-022-02448-4 . - DOI - PubMed - PMC
1. Appavu B, Deng D, Dowling MM, et al. Arteritis and large vessel occlusive strokes in children after COVID-19 infection. Pediatrics. 2021;147:e2020023440. https://doi.org/10.1542/peds.2020-023440 . - DOI - PubMed
1. Španělová K, Skříšovská T, Mužlayová P, et al. Cerebrovascular complications of COVID-19 disease in children: a single-center case series. Pediatr Neurol. 2022;134:18–24. https://doi.org/10.1016/j.pediatrneurol.2022.06.007 . - DOI - PubMed - PMC
1. Cocciolillo F, Di Giuda D, Morello R, et al. Orbito-frontal cortex hypometabolism in children with post-COVID condition (long COVID): a preliminary experience. Pediatr Infect Dis J. 2022;41:663–5. https://doi.org/10.1097/INF.0000000000003578 . - DOI - PubMed - PMC

Publication types

Actions

LinkOut - more resources

Full Text Sources
- Springer
Miscellaneous
- NCI CPTAC Assay Portal

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Persistent neurological sequelae in children and adolescents after SARS-CoV-2: a scoping review

Affiliations

Persistent neurological sequelae in children and adolescents after SARS-CoV-2: a scoping review

Authors

Affiliations

Abstract

Conflict of interest statement

References

Publication types

LinkOut - more resources

Full Text Sources

Miscellaneous