Continuous EEG findings in patients with COVID‐19 infection admitted to a New York academic hospital system

Abstract

Objective: There is evidence for central nervous system complications of coronavirus disease 2019 (COVID-19) infection, including encephalopathy. Encephalopathy caused by or arising from seizures, especially nonconvulsive seizures (NCS), often requires electroencephalography (EEG) monitoring for diagnosis. The prevalence of seizures and other EEG abnormalities among COVID-19-infected patients is unknown. Methods: Medical records and EEG studies of patients hospitalized with confirmed COVID-19 infections over a 2-month period at a single US academic health system (four hospitals) were reviewed to describe the distribution of EEG findings including epileptiform abnormalities (seizures, periodic discharges, or nonperiodic epileptiform discharges). Factors including demographics, remote and acute brain injury, prior history of epilepsy, preceding seizures, critical illness severity scores, and interleukin 6 (IL-6) levels were compared to EEG findings to identify predictors of epileptiform EEG abnormalities. Results: Of 111 patients monitored, most were male (71%), middle-aged or older (median age 64 years), admitted to an intensive care unit (ICU; 77%), and comatose (70%). Excluding 11 patients monitored after cardiac arrest, the most frequent EEG finding was moderate generalized slowing (57%), but epileptiform findings were observed in 30% and seizures in 7% (4% with NCS). Three patients with EEG seizures did not have epilepsy or evidence of acute or remote brain injury, although all had clinical seizures prior to EEG. Only having epilepsy (odds ratio [OR] 5.4, 95% confidence interval [CI] 1.4-21) or seizure(s) prior to EEG (OR 4.8, 95% CI 1.7-13) was independently associated with epileptiform EEG findings. Significance: Our study supports growing evidence that COVID-19 can affect the central nervous system, although seizures are unlikely a common cause of encephalopathy. Seizures and epileptiform activity on EEG occurred infrequently, and having 2098 |

Electroencephalographic Abnormalites in SARS-CoV-2 Patients

“…In addition, a previous spectral analysis study of the EEG confirmed the electrical changes in case of encephalopathy, even suggesting the ability to differentiate between infectious toxic encephalopathy on the one hand, and from encephalopathies in a context of severe hypoxia on the second hand (16). The proportion of altered EEG of about 85% reported here regardless the medical indication, was similar to those previously reported (15,17). Viral infection with COVID 19 in patients with epilepsy may trigger or worse epileptic seizures more easily, particularly in the case of genetic abnormalities (18).…”

“…One study reports nearly 41% of epileptiform abnormalities with 88% of frontals sharp waves. The proportion of EEG anomalies in favor of encephalopathy was 18% (14) for 21% in our study while Pellinen et al (15) reported moderated generalized slowing for 57%. In addition, a previous spectral analysis study of the EEG confirmed the electrical changes in case of encephalopathy, even suggesting the ability to differentiate between infectious toxic encephalopathy on the one hand, and from encephalopathies in a context of severe hypoxia on the second hand (16).…”

“…EEG in a patient who is suspect or positive for COVID 19 was mainly prescribed from signs of encephalopathy or seizure as previously reported (13)(14)(15). Out of 42 EEGs performed, 9 were suggestive of encephalopathy.…”

Electroencephalographic Abnormalities are Common in COVID‐19 and are Associated with Outcomes

“…These are not unexpected, because clinical seizures before EEG are associated with electrographic seizures on EEG, 12 and patients with prior neurologic injury are known to be at higher risk for nonconvulsive seizures. 9 Of note, the study by Pellinen and colleagues 19 also reported a suspected clinical seizure before EEG as a risk factor for electrographic seizures. Interestingly, in our study, the maximal fibrinogen level was inversely associated with the risk of seizures; this could reflect the possibility that COVID-19 provoked seizures in patients with epilepsy even in the absence of a significant systemic inflammatory response.…”

Epilepsy and COVID-19: Updated evidence and narrative review

“…Several reports have described EEG results in patients affected by COVID-19 [26][27][28][29][30]. In most case series, EEG testing is performed following a seizure or altered consciousness, on suspicion of acute symptomatic seizures or encephalopathy [26][27][28][29]. Many of those reports have found no COVID-19-specific findings that would lead to suspicion of COVID-19 infection based on EEG testing [26][27][28].…”