Abstract
Critical illness and sepsis are commonly associated with subclinical seizures. COVID-19 frequently causes severe critical illness, but the incidence of electrographic seizures in patients with COVID-19 has been reported to be low. This retrospective case series assessed the incidence of and risks for electrographic seizures in patients hospitalized with COVID-19 who underwent continuous video electroencephalography monitoring (cvEEG) between March 1st, 2020 and June 30th, 2020. One hundred and twenty-two patients were initially identified who resulted SARS-CoV-2 nasopharyngeal RT-PCR swab positivity with any electroencephalography order placed in the EMR. Seventy-nine patients met study inclusion criteria: age ≥18 years, >1 h of cvEEG monitoring, and positive SARS-CoV-2 nasopharyngeal swab PCR. Six (8%) of the 79 patients suffered electrographic seizures (ES), three of whom suffered non-convulsive status epilepticus. Acute hyperkinetic movements were the most common reason for cvEEG in patients with ES (84%). None of the patients undergoing cvEEG for persistent coma (29% of all patients) had ES. Focal slowing (67 vs. 10%), sporadic interictal epileptiform discharges (EDs; 33 vs. 6%), and periodic/rhythmic EDs (67 vs. 1%) were proportionally more frequent among patients with electrographic seizures than those without these seizures. While 15% of patients without ES had generalized periodic discharges (GPDs) with triphasic morphology on EEG, none of the patients with ES had this pattern. Further study is required to assess the predictive values of these risk factors on electrographic seizure incidence and subsequent outcomes.
Highlights
Coronavirus disease 2019 (COVID-19) has been associated with several neurological syndromes [1]
The patients in the larger study were not monitored with continuous video electroencephalography, so it is possible that these patients had electrographic subclinical seizures
We detected electrographic seizures in six of 79 patients with COVID-19 that underwent EEG monitoring, three of whom had new-onset seizures. This is a small percentage of patients suffering from electrographic seizures, and most were in the setting of hyperkinetic movements, acute neurologic disease on admission, and prior history of epilepsy or neurologic disease
Summary
Coronavirus disease 2019 (COVID-19) has been associated with several neurological syndromes [1]. The existing literature suggests that the incidence of seizures in COVID-19 patients is relatively low. Small case series have described new-onset electrographic seizures [2, 3]—both clinical and subclinical—and status epilepticus [4] in patients with COVID-19, but a larger retrospective review including 304 COVID-19 patients did not find any cases of clinical seizures [5]. The patients in the larger study were not monitored with continuous video electroencephalography (cvEEG), so it is possible that these patients had electrographic subclinical seizures. The goal of this study is to describe the results of 257 EEG days across 79 patients as well as to identify the incidence of, and risk factors for, detecting seizures on cvEEG
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