Pharmacological management of seizures in patients with COVID-19: a systematic review

Priscilla Kolibea Mante,John-Paul Omuojine,Nana Ofori Adomako,Paulina Antwi

doi:10.12688/aasopenres.13224.1

Abstract

Background: Some patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been reported to exhibit neurological symptoms such as seizures and impaired consciousness. Our study reviews reported cases to assess the pharmacological approach to managing seizures in SARS-CoV-2 patients and associated outcomes. Methods: A systematic review of case reports on the incidence of seizures following coronavirus disease 2019 (COVID-19) among patients that reported use of antiepileptic drugs (AEDs) in management was performed by using the PRISMA (preferred reporting items for systematic reviews and meta-analysis) guidelines. Databases used included EMBASE, PubMed, SCOPUS, and Google Scholar. Data was presented as qualitative and descriptive data. Results: In total, 67 articles were selected for full-text assessment, of which 19 were included in the final review. Patients had a median age of 54 years, most of whom were male. Remdisivir, dexamethasone, Laminavir, hydroxychloroquine, azithromycin, and Lopinavir-ritonavir were common agents used in the management of COVID-19. Most patients presented with either generalized tonic-clonic seizures or status epilepticus. Most patients received levetiracetam as drug choice or as part of their regimen. Other AEDs commonly prescribed included midazolam and sodium valproate. Some patients received no antiepileptic drug therapy. Most of the patients who died had more than one comorbidity. Also, most of the patients who died received COVID-19 treatment drugs. None of the patients who received midazolam as drug choice or as part of their regimen developed recurrent seizures in contrast to patients who received levetiracetam and sodium valproate as drug choice or as part of their regimen. Interestingly, none of the patients who received no AEDs suffered recurrent seizures or died. Conclusions: Standard guidelines for managing seizures in COVID-19 patients may be required. A limitation of this review is that it involved the use of case reports with no controls and a small number of patients.

Highlights

Neurological manifestations have been reported in about one-third of patients with coronavirus disease 2019 (COVID-19)
A limitation of this review is that it involved the use of case reports with no controls and a small number of patients
This article is included in the Coronavirus (COVID-19) collection

Summary

Introduction

Neurological manifestations have been reported in about one-third of patients with coronavirus disease 2019 (COVID-19). Several case studies on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have demonstrated neurological effects such as strokes, loss of consciousness, encephalopathy, generalized tonic-clonic convulsions and neuralgia (Beyls et al, 2020). This is not entirely surprising as SARS-CoV-1 and Middle East respiratory syndrome coronavirus (MERS-CoV) have previously been associated with sporadic neuropathological changes (Desforges et al, 2020; Lau et al, 2004). Some patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been reported to exhibit neurological symptoms such as seizures and impaired consciousness. Our study reviews reported cases to assess the pharmacological approach to managing seizures in SARS-CoV-2 patients and associated outcomes. None of the patients who received no AEDs suffered recurrent seizures or died

Objectives

Methods

Results