COVID-19 EEG Studies: The Other Coronavirus Spikes We Need to Worry About.

Abstract

Report of Electroencephalographic Finding on Critically Ill Patients With COVID-19 Vespignani H, Colas D, Lavin BS, et al. Ann Neurol. 2020. https://onlinelibrary.wiley.com/doi/full/10.1002/ana.25814 In March 2020, we treated a cohort of 26 critically ill hospitalized SARS-CoV-2 infected patients who received EEGs to assess unexplained altered mental status, loss of consciousness, or poor arousal and responsiveness. Of the 26 patients studied, 5 patients had EEGs that showed periodic discharges (PD) consisting of high amplitude frontal monomorphic delta waves with absence of epileptic activity. These findings may suggest CNS injury potentially related to COVID-19 in these patients. EEG Findings in Acutely Ill Patients Investigated for SARS-CoV-2/COVID-19: A Small Case Series Preliminary Report Galanopoulou AS, Ferastraoaru V, Correa DJ, et al. Epilepsia Open. 2020;5(2):314-324. https://doi.org/10.1002/epi4.12399 Objective:Acute encephalopathy may occur in COVID-19-infected patients. We investigated whether medically indicated EEGs performed in acutely ill patients under investigation (PUIs) for COVID-19 report epileptiform abnormalities and whether these are more prevalent in COVID-19 positive than negative patients.Methods:In this retrospective case series, adult COVID-19 inpatient PUIs underwent EEGs for acute encephalopathy and/or seizure-like events. PUIs had 8-channel headband EEGs (Ceribell; 20 COVID-19 positive, 6 COVID-19 negative); 2 more COVID-19 patients had routine EEGs. Overall, 26 Ceribell EEGs, 4 routine, and 7 continuous EEG studies were reviewed. EEGs were interpreted by board-certified clinical neurophysiologists (n = 16). EEG findings were correlated with demographic data, clinical presentation and history, and medication usage. Fisher exact test was used.Results:We included 28 COVID-19 PUIs (30-83 years old), of whom 22 tested positive (63.6% males) and 6 tested negative (33.3% male). The most common indications for EEG, among COVID-19-positive versus COVID-19-negative patients, respectively, were new onset encephalopathy (68.2% vs 33.3%) and seizure-like events (14/22, 63.6%; 2/6, 33.3%), even among patients without prior history of seizures (11/17, 64.7%; 2/6, 33.3%). Sporadic epileptiform discharges (EDs) were present in 40.9% of COVID-19-positive and 16.7% of COVID-19-negative patients; frontal sharp waves were reported in 8/9 (88.9%) of COVID-19-positive patients with EDs and in 1/1 of COVID-19-negative patient with EDs. No electrographic seizures were captured, but 19/22 COVID-19-positive and 6/6 COVID-19-negative patients were given anti-seizure medications and/or sedatives before the EEG.Significance:This is the first preliminary report of EDs in the EEG of acutely ill COVID-19-positive patients with encephalopathy or suspected clinical seizures. EDs are relatively common in this cohort and typically appear as frontal sharp waves. Further studies are needed to confirm these findings and evaluate the potential direct or indirect effects of COVID-19 on activating epileptic activity. Electroencephalogram (EEG) in COVID-19: A systematic Retrospective Study Petrescu AM, Taussig D, Bouilleret V. Neurophysiol Clin. 2020;50(3):155-165. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7315937/ Objectives:Although rare, neurological manifestations in SARS-CoV-2 infection are increasingly being reported. We conducted a retrospective systematic study to describe the electroencephalography (EEG) characteristics in this disease, looking for specific patterns.Methods:EEGs performed in patients with positive PCR for SARS-CoV-2 between March 25, 2020 and May 06, 2020 in the University Hospital of Bicetre were independently reviewed by 2 experienced neurologists. We used the American Clinical Neurophysiology Society’s terminology for the description of abnormal patterns. EEGs were classified into 5 categories, from normal to critically altered. Interobserver reliability was calculated using Cohen kappa coefficient. Medical records were reviewed to extract demographics, clinical, imaging, and biological data.Results:Forty EEGs were reviewed in 36 COVID-19 patients, 18 in intensive care units (ICU) and 22 in medicine units. The main indications were confusion or fluctuating alertness for 23 (57.5%) and delayed awakening after stopping sedation in ICU in 6 (15%). EEGs were normal to mildly altered in 23 (57.5%) contrary to the 42.5% where EEG alterations were moderate in 4 (10%), severe in 8 (20%), and critical in 5 (12.5%). Generalized periodic discharges (GPDs), multifocal periodic discharges (MPDs), or rhythmic delta activity (RDA) were found in 13 recordings (32.5%). EEG alterations were not stereotyped or specific. They could be related to an underlying morbid status, except for 3 ICU patients with unexplained encephalopathic features.Conclusion:In this first systematic analysis of COVID-19 patients who underwent EEG, over half of them presented a normal recording pattern. EEG alterations were not different from those encountered in other pathological conditions.