key: cord-0850264-itooaexp
authors: Gupta, Juhi; Madaan, Priyanka; Chowdhury, Sayoni Roy; Gulati, Sheffali
title: COVID-19 and Pediatric Neurology practice in a Developing country
date: 2020-08-26
journal: Pediatr Neurol
DOI: 10.1016/j.pediatrneurol.2020.08.016
sha: 3e1fb58f425a69c2cd19cebabc9bb4b074c63b7b
doc_id: 850264
cord_uid: itooaexp

nan

We read with great interest the article by Pavlakis et al summarizing the scenario in New York City during the COVID-19 pandemic and providing an approach for managing the associated neurological complications [1] . The authors highlight the role of "thromboinflammation" in the pathogenesis in adults. However, its role in children is debatable.

Besides, the authors mention that neurological dysfunction secondary to COVID-19 in children is limited to reports. We concur with authors and would like to mention the other evolving hypotheses for COVID-19 pathogenesis in children and underscore the distinctive challenges faced by pediatric neurologists in a developing country.

Vasculitis (endothelitis) and delayed overactivation of the STING pathway are other proposed hypotheses underlying complications of COVID -19 in children such as Kawasakilike disease, chill blains, hemophagocytic lymphohistiocytosis, etc [2] . Several age-related factors such as enhanced thrombin inhibition due to elevated α2-Macroglobulin are considered protective against thrombotic complications in children [3] . Serial assessments of various coagulation parameters along with disseminated-intravascular-coagulation scoring and risk factor-based approach should be followed in children, considering our limited understanding of the disease [4] . The expanding spectrum of COVID-19 in children includes various neurological manifestations like refractory status epilepticus, encephalitis, central apnea, Guillain-barre syndrome [5] [6] [7] . As some of them may adversely affect the long-term neurodevelopmental outcome, these children should be followed-up. Evidence of elevated levels of serum neurofilament light chain (marker of neuro-axonal destruction) in COVID-19 patients with mild-to-moderate symptoms, reinforces this concern [8].

The challenges faced by pediatric neurologists in a developing country are distinctive. Only a few centers including ours run round-the-clock child neurology tele-helpline and teleconsultation services but restricted availability of video-calling and internet facility at rural households limits their efficient use. Besides, specialized facilities such as dietary therapy and surgery for drug-refractory epilepsy, etc. are offered at few centers only. Due to the fear of contracting this disease and travel restrictions, it becomes difficult for caregivers to access these specialized centers. Hence, the treatment gap for various neurological disorders is expected to increase with this burgeoning pandemic [9] . In our practice, we have observed an increase in the number of children presenting in advanced stages of neurotuberculosis and other neurological disorders post lockdown, possibly due to delay in seeking initial advice for mild symptoms. Also, with the economic slowdown, the expenditure on healthcare takes a backseat for many families who struggle to make the ends meet.

Empowering primary health-care workers, strengthening essential services such as immunization, and developing telemedicine facilities are some of the key strategies to achieve optimum care in resource-constrained settings.

J o u r n a l P r e -p r o o f

Fear and Understanding in the Time of COVID-19

Kawasaki-like diseases and thrombotic coagulopathy in COVID-19: delayed over-activation of the STING pathway?

COVID-19-associated coagulopathy -Hypothesis: Are Children protected due to enhanced thrombin inhibition by higher α 2 -Macroglobulin (α2-M)?

COVID-19 anticoagulation recommendations in children

Guillain-Barré Syndrome Associated with SARS-CoV-2 Infection in a Pediatric Patient

Encephalitis Associated with COVID-19 Infection in an 11-Year-Old Child

Central Apnea in an Adolescent With COVID-19

Association of neuronal injury blood marker neurofilament light chain with mild-tomoderate COVID-19

COVID-19 and Child Neurology Care